Basic Information
| Provider Information | |||||||||
| NPI: | 1194974691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTELLANOS | ||||||||
| FirstName: | GEORGINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 S BEAUDRY AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132413841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 333 S BEAUDRY AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132413841 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 31850 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 65922 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.