Provider Demographics
NPI:1457645731
Name:CASTELLANO, VICTORIA ROSE (MT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ROSE
Other - Last Name:LUJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8955 RIDGELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2362
Mailing Address - Country:US
Mailing Address - Phone:720-488-4100
Mailing Address - Fax:
Practice Address - Street 1:8955 RIDGELINE BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2362
Practice Address - Country:US
Practice Address - Phone:720-488-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5656225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist