Chanel Chew Castillo

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

101938 Issued in CA

Practice address

30290 Skippers Way Dr
Canyon Lake, CA 92587

Phone

(909) 762-7048

NPI assigned

Mar 8, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530835200000",
    "number": "1316308166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30290 SKIPPERS WAY DR",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925877406",
            "telephone_number": "909-762-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30290 SKIPPERS WAY DR",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "92587",
            "telephone_number": "909-762-7048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7967 Broadway",
            "address_purpose": "LOCATION",
            "city": "Lemon Grove",
            "state": "CA",
            "postal_code": "919451809",
            "country_code": "US",
            "telephone_number": "619-741-9416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTILLO",
        "first_name": "CHANEL",
        "middle_name": "CHEW",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-08",
        "last_updated": "2018-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "101938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IEHP",
            "identifier": "20160200868801",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Renee Burgess
• California Medical Supply
• Canyon Consulting Group
• Canyon Lake Physical Therapy, Inc
• Casa de Lago
• Garrett Chase
• Dawn Chatigny, LAC
• Lorna Lyanthie Conyers, PHD
• Mary Lucinda Demoss, OD
• Alex Denes, MD

• General Practice Dentistry in Canyon Lake, CA
• Providers in Canyon Lake, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.