Healthcare Provider Details

I. General information

NPI: 1912759077
Provider Name (Legal Business Name): PETER MICHAEL CASTILLO LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 EUCALYPTUS DR
BAKERSFIELD CA
93306-6075
US

IV. Provider business mailing address

9902 FIRE ISLAND DR
BAKERSFIELD CA
93313-4890
US

V. Phone/Fax

Practice location:
  • Phone: 661-363-5947
  • Fax:
Mailing address:
  • Phone: 661-586-3855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN242241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: