Individual
MARIO EDUARDO CASTELLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W THOMAS RD, SUITE 680, PHOENIX, AZ 85013-4224
(602) 406-6017
Mailing address
FILE 56765, LOS ANGELES, CA 90074-6765
(602) 406-3860
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
42762
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
588582
—
AZ
01
—
BP1-0026446
INSTITUTIONAL PERMIT
—
Enumeration date
06/06/2007
Last updated
06/11/2012
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