Individual provider Active NPI

Raul G Castellanos Jr., DDS

  • Dentist
  • Pico Rivera, CA
National Provider Identifier
1174530802
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
27411 Issued in CA
Practice address
9519 Telegraph Rd
Ste D
Pico Rivera, CA 90660
Phone
(562) 942-2625
Fax
(562) 949-4975
NPI assigned
Aug 2, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 27411 CA Primary

Addresses

Primary practice location

9519 Telegraph Rd
Ste D
Pico Rivera, CA 90660

Mailing address

9519 Telegraph Rd
Ste D
Pico Rivera, CA 90660
Phone (562) 942-2625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160503000674 CA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8820397474

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174530802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9519 TELEGRAPH RD",
            "address_2": "STE D",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "90660",
            "telephone_number": "562-942-2625",
            "fax_number": "562-949-4975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9519 TELEGRAPH RD",
            "address_2": "STE D",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "90660",
            "telephone_number": "562-942-2625",
            "fax_number": "562-949-4975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTELLANOS",
        "first_name": "RAUL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "27411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pico Rivera, CA

Sources for this page

Verify at the official NPI Registry.