Provider Demographics
NPI:1386104230
Name:CASTELLON, GEMA
Entity type:Individual
Prefix:
First Name:GEMA
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 1:34016 WALNUT CREEK RD.
Mailing Address - Street 2:
Mailing Address - City:WIDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595
Mailing Address - Country:US
Mailing Address - Phone:951-746-4578
Mailing Address - Fax:
Practice Address - Street 1:27168 NEWPORT RD SUITE D4
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584
Practice Address - Country:US
Practice Address - Phone:951-800-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712141163W00000X
CA95030915363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health