Provider Demographics
NPI:1770395774
Name:CASTELLON, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
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 1:1311 S HIGHLAND AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3347
Mailing Address - Country:US
Mailing Address - Phone:714-476-1843
Mailing Address - Fax:
Practice Address - Street 1:1311 S HIGHLAND AVE APT 202
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-3347
Practice Address - Country:US
Practice Address - Phone:714-476-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer