1306069653 NPI number — CAROLE A CASTEEN M.D., P.C.

Table of content: (NPI 1306069653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306069653 NPI number — CAROLE A CASTEEN M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLE A CASTEEN M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306069653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22650
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93390-2650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-663-9090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 CALLOWAY DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-663-9090
Provider Business Practice Location Address Fax Number:
661-829-6754
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTEEN
Authorized Official First Name:
CAROLE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
661-663-9090

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G50991 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: G50991 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0584260001 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G509910 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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