Provider Demographics
NPI:1033186614
Name:CASTELLANO, ANGELA (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:J
Other - Last Name:CASTELLANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:516
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-789-6296
Mailing Address - Fax:818-789-0374
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:516
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-789-6296
Practice Address - Fax:818-789-0374
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28757207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC353986Medicare UPIN
C353986Medicare UPIN