Provider Demographics
NPI:1750300521
Name:MARIANO, JEFFREY DE CASTRO (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DE CASTRO
Last Name:MARIANO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3699 WILSHIRE BLVD
Mailing Address - Street 2:3RD FLOOR KAISER DEPT OF CONTINUING CARE
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2718
Mailing Address - Country:US
Mailing Address - Phone:323-783-1490
Mailing Address - Fax:323-783-4120
Practice Address - Street 1:3699 WILSHIRE BLVD
Practice Address - Street 2:3RD FLOOR KAISER DEPT OF CONTINUING CARE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2718
Practice Address - Country:US
Practice Address - Phone:323-783-1490
Practice Address - Fax:323-783-4120
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA81061207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A810610Medicaid
CA00A810610Medicaid
CAWA81061AMedicare PIN
CAWA81061BMedicare PIN