Provider Demographics
NPI:1679769897
Name:CASTUERA, MIGUEL A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:CASTUERA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-4116
Mailing Address - Country:US
Mailing Address - Phone:909-624-3033
Mailing Address - Fax:909-624-8440
Practice Address - Street 1:4451 HOLT BLVD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4116
Practice Address - Country:US
Practice Address - Phone:909-624-3033
Practice Address - Fax:909-624-8440
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13087208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH47353Medicare UPIN