Healthcare Provider Details

I. General information

NPI: 1407165079
Provider Name (Legal Business Name): RONALD CASTILLO TEJADA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20920 CHICO ST
CARSON CA
90746-3603
US

IV. Provider business mailing address

3300 E SOUTH ST SUITE 205
LAKEWOOD CA
90805-4549
US

V. Phone/Fax

Practice location:
  • Phone: 424-444-5097
  • Fax: 833-973-3630
Mailing address:
  • Phone: 562-531-0377
  • Fax: 562-531-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA118334
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036130801
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: