Provider Demographics
NPI:1568624559
Name:CASTANO, CAROLINA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:CASTANO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W 17TH ST
Mailing Address - Street 2:1
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3614
Mailing Address - Country:US
Mailing Address - Phone:714-972-2727
Mailing Address - Fax:714-972-1193
Practice Address - Street 1:520 W 17TH ST
Practice Address - Street 2:1
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3614
Practice Address - Country:US
Practice Address - Phone:714-972-2727
Practice Address - Fax:714-972-1193
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16252363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16252OtherCA STATE LICENSE
CAPA16252OtherCA STATE LICENSE