Provider Demographics
NPI:1497311971
Name:CASTANO, MARIANO (CMT, CCM)
Entity type:Individual
Prefix:
First Name:MARIANO
Middle Name:
Last Name:CASTANO
Suffix:
Gender:M
Credentials:CMT, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 E THOUSAND OAKS BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-206-7615
Mailing Address - Fax:805-870-7339
Practice Address - Street 1:1429 E THOUSAND OAKS BLVD
Practice Address - Street 2:STE 103
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-231-2091
Practice Address - Fax:805-870-7339
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-1608665OtherLAC