Provider Demographics
NPI:1407616741
Name:CASTELLANOS, KATELYN (DO)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MARTIN LUTHER KING JR. WAY
Mailing Address - Street 2:MAILSTOP 315-5C-TFM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-792-6680
Mailing Address - Fax:
Practice Address - Street 1:315 MARTIN LUTHER KING JR. WAY
Practice Address - Street 2:MAILSTOP 315-5C-TFM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-792-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program