Basic Information
| Provider Information | |||||||||
| NPI: | 1073905105 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSE GABRIEL CASTELLANOS, MD, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | COVINA URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 E BADILLO ST | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917232115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269159992 | ||||||||
| FaxNumber: | 6269156108 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 E BADILLO ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917232846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267329232 | ||||||||
| FaxNumber: | 6267329623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2015 | ||||||||
| LastUpdateDate: | 12/21/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CASTELLANOS | ||||||||
| AuthorizedOfficialFirstName: | DARIO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6268593297 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JOSE GABRIEL CASTELLANOS, MD, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | A62398 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.