Individual
MISS CHANEL CHEW CASTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30290 SKIPPERS WAY DR, CANYON LAKE, CA 92587
(909) 762-7048
Mailing address
30290 SKIPPERS WAY DR, CANYON LAKE, CA 92587-7406
(909) 762-7048
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
101938
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20160200868801
IEHP
CA
Enumeration date
03/08/2016
Last updated
07/06/2018
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