Provider Demographics
NPI:1497311971
Name:CASTANO, MARIANO (MCT)
Entity Type:Individual
Prefix:
First Name:MARIANO
Middle Name:
Last Name:CASTANO
Suffix:
Gender:M
Credentials:MCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 OLD CONEJO RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2115
Mailing Address - Country:US
Mailing Address - Phone:805-285-5311
Mailing Address - Fax:805-870-7339
Practice Address - Street 1:3307 OLD CONEJO RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2115
Practice Address - Country:US
Practice Address - Phone:805-285-5311
Practice Address - Fax:805-870-7339
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-1608665OtherLAC