MEDICARE: TONY 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	247100000X	Radiologic Technologist	RHF67105	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821159179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONY CASTILLO

Provider Business Mailing Address
First Line	:	PO BOX 4427
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92702-4427
Country	:	US
Telephone Number	:	714-835-2915
Fax Number	:	714-543-3114

Provider Business Practice Location Address
First Line	:	1651 E 4TH ST
Second Line	:	SUITE 212
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5164
Country	:	US
Telephone Number	:	714-835-2915
Fax Number	:	714-543-3114

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/09/2007

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Directions to “ TONY CASTILLO ” Practice Location

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