Provider Demographics
NPI:1720316078
Name:CONRAD CASTELLINO M.D. INC.
Entity Type:Organization
Organization Name:CONRAD CASTELLINO M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:JOACHIM
Authorized Official - Last Name:CASTELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-383-4028
Mailing Address - Street 1:520 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2833
Mailing Address - Country:US
Mailing Address - Phone:209-383-4028
Mailing Address - Fax:209-383-4062
Practice Address - Street 1:520 W 27TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2833
Practice Address - Country:US
Practice Address - Phone:209-383-4028
Practice Address - Fax:209-383-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care