Provider Demographics
NPI:1083833743
Name:CASTELLANOS, DIANA LYNN (ADV CST, LMT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:ADV CST, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2856 CABRILLO DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2858
Mailing Address - Country:US
Mailing Address - Phone:805-653-6008
Mailing Address - Fax:805-653-6085
Practice Address - Street 1:2856 CABRILLO DR STE 101
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2858
Practice Address - Country:US
Practice Address - Phone:805-653-6008
Practice Address - Fax:805-653-6085
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist