Provider Demographics
NPI:1912532771
Name:CASTELLANOS FERRER, JAVIANNA VANESSA
Entity Type:Individual
Prefix:
First Name:JAVIANNA
Middle Name:VANESSA
Last Name:CASTELLANOS FERRER
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 1:40 BICKEL CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5721
Mailing Address - Country:US
Mailing Address - Phone:703-371-3473
Mailing Address - Fax:
Practice Address - Street 1:7633 E JEFFERSON AVE STE 70
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3730
Practice Address - Country:US
Practice Address - Phone:313-499-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program