Basic Information
| Provider Information | |||||||||
| NPI: | 1518488584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTRELLON | ||||||||
| FirstName: | ALONSO | ||||||||
| MiddleName: | JAVIER | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15015 S NORMANDIE AVE APT 13 | ||||||||
| Address2: | |||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902472998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242234064 | ||||||||
| FaxNumber: | 4242234064 | ||||||||
| Practice Location | |||||||||
| Address1: | 12881 KNOTT ST | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928413925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148926828 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3870 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.