MEDICARE: GEMA CASTILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BEH-000705	AZ
2	103K00000X	Behavior Analyst	1-19-37229	AZ

General Provider Information

NPI Number	:	1619523875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEMA CASTILLO

Provider Business Mailing Address
First Line	:	PO BOX 33568
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92163-3568
Country	:	US
Telephone Number	:	855-223-7213
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 W BELL RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8551
Country	:	US
Telephone Number	:	855-223-7213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	11/25/2025

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Directions to “ GEMA CASTILLO ” Practice Location

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