Provider Demographics
NPI:1023696838
Name:CASTANON VELASQUEZ, JARVIN OMAR
Entity type:Individual
Prefix:
First Name:JARVIN
Middle Name:OMAR
Last Name:CASTANON VELASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 GALILEO CT STE 101
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4882
Mailing Address - Country:US
Mailing Address - Phone:530-747-7243
Mailing Address - Fax:
Practice Address - Street 1:1947 GALILEO CT STE 101
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4882
Practice Address - Country:US
Practice Address - Phone:530-747-7253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician