Provider Demographics
NPI:1275922544
Name:CASTILLO, CELENA
Entity Type:Individual
Prefix:MS
First Name:CELENA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13021 CENTRAL AVE
Mailing Address - Street 2:303
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5879
Mailing Address - Country:US
Mailing Address - Phone:626-890-6917
Mailing Address - Fax:
Practice Address - Street 1:13021 CENTRAL AVE
Practice Address - Street 2:303
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5879
Practice Address - Country:US
Practice Address - Phone:626-890-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist