Provider Demographics
NPI:1518488584
Name:CASTRELLON, ALONSO JAVIER (COTA)
Entity type:Individual
Prefix:
First Name:ALONSO
Middle Name:JAVIER
Last Name:CASTRELLON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 S NORMANDIE AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2998
Mailing Address - Country:US
Mailing Address - Phone:424-223-4064
Mailing Address - Fax:424-223-4064
Practice Address - Street 1:12881 KNOTT ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3925
Practice Address - Country:US
Practice Address - Phone:714-892-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3870224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant