Provider Demographics
NPI:1538384607
Name:CASTELLANOS, LUIS G
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29064 OVERBOARD DR
Mailing Address - Street 2:
Mailing Address - City:ROMOLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92585-3141
Mailing Address - Country:US
Mailing Address - Phone:909-472-6886
Mailing Address - Fax:
Practice Address - Street 1:9707 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3609
Practice Address - Country:US
Practice Address - Phone:951-358-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral