Provider Demographics
NPI:1023846912
Name:ANTONIO CASTELLANOS VEJAR
Entity type:Organization
Organization Name:ANTONIO CASTELLANOS VEJAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLANOS VEJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:664-764-8884
Mailing Address - Street 1:3975 CAMINO DE LA PLZ # 208-7319
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-5919
Mailing Address - Country:US
Mailing Address - Phone:664-764-8884
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO ORION 7377 INT 204
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:664-764-8884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty