Provider Demographics
NPI:1982811204
Name:JAIME, TERESITA CASTILLO (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:CASTILLO
Last Name:JAIME
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4942
Mailing Address - Country:US
Mailing Address - Phone:626-577-5624
Mailing Address - Fax:
Practice Address - Street 1:275 S ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4942
Practice Address - Country:US
Practice Address - Phone:626-577-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist