| Virginia Castelo Dmd.a Dental Corporation | |
|
1321 N Vermont Ave Ste 4 Los Angeles CA 90027-6307 | |
| (323) 666-3852 | |
| Not Available |
| Full Name | Virginia Castelo Dmd.a Dental Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 1321 N Vermont Ave Ste 4, Los Angeles, California |
| Authorized Official Name and Position | Virignia C Castelo (PRESIDENT) |
| Authorized Official Contact | 3236663852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Virginia Castelo Dmd.a Dental Corporation 1321 N Vermont Ave Ste 4 Los Angeles CA 90027-6307 Ph: (323) 666-3852 | Virginia Castelo Dmd.a Dental Corporation 1321 N Vermont Ave Ste 4 Los Angeles CA 90027-6307 Ph: (323) 666-3852 |
| NPI Number | 1043528607 |
|---|---|
| Provider Enumeration Date | 09/16/2010 |
| Last Update Date | 09/16/2010 |
| Medicare PECOS PAC ID | 1456669258 |
|---|---|
| Medicare Enrollment ID | O20150928002334 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043528607 | NPI | - | NPPES |
| G 93846 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 40554 (California) | Primary |
| Provider Name | Virginia Castelo |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1124004742 PECOS PAC ID: 4981911666 Enrollment ID: I20150928001931 |
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