Provider Demographics
NPI:1134752322
Name:CASTELLON, SAMANTHA JASMINE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JASMINE
Last Name:CASTELLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1924
Mailing Address - Country:US
Mailing Address - Phone:661-868-6840
Mailing Address - Fax:661-861-1020
Practice Address - Street 1:2001 28TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1924
Practice Address - Country:US
Practice Address - Phone:661-868-6840
Practice Address - Fax:661-861-1020
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist