Provider Demographics
NPI:1356196653
Name:CASTELLO, JORDAN RAIN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:RAIN
Last Name:CASTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:RAIN
Other - Last Name:CASTELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA STUDENT
Mailing Address - Street 1:9055 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1509
Mailing Address - Country:US
Mailing Address - Phone:951-345-2848
Mailing Address - Fax:
Practice Address - Street 1:9055 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1509
Practice Address - Country:US
Practice Address - Phone:951-345-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program