Raul G Castellanos Jr., DDS
Individual provider Active NPI Dentist · Pico Rivera, CA
NPI 1174530802 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1174530802
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 27411 (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
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160503000674 | CA | Order and Referring Only - Oral Surgery |
8820397474 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 27411 | CA | Yes |
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
Other providers in Pico Rivera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.