1710769096 NPI number — MRS. JANICE LOUISE CASTEEL LEP

Table of content: MRS. JANICE LOUISE CASTEEL LEP (NPI 1710769096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710769096 NPI number — MRS. JANICE LOUISE CASTEEL LEP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTEEL
Provider First Name:
JANICE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LEP
Provider Gender Code:
F

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:
1710769096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33601 PORT MARINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-2149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-287-1042
Provider Business Mailing Address Fax Number:
949-429-1823

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 BIRCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-287-1042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  LEP1850 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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