| Doctor Name: | SALLY E. DECASTRO-TILSEN |
| NPI Number: | 1023282019 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A. |
| License Number: | PA 10296 |
| Business Practice Address: | 400 Newport Center Dr Ste 701 Newport Beach, CA - 926607608 |
| Business Phone Number: | 9497598001 |
| Business Fax Number: | 9497603671 |
| Mailing Address: | 1101 White Sails Way, CORONA DEL MAR |
| State: | CA |
| Postal Code: | 926251524 |
| Phone Number: | 9493788641 |
| Fax Number: | 9497603671 |
| NPI Enumeration Date: | 04/22/2008 |
| NPI Last Update Date: | 04/22/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA 10296 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |