Healthcare Provider Details

I. General information

NPI: 1255126363
Provider Name (Legal Business Name): CHRISTOPHER CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 VICTORIA ST STE 1H
COSTA MESA CA
92627-1906
US

IV. Provider business mailing address

275 VICTORIA ST STE 1H
COSTA MESA CA
92627-1906
US

V. Phone/Fax

Practice location:
  • Phone: 949-629-2860
  • Fax: 949-629-2867
Mailing address:
  • Phone: 949-629-2860
  • Fax: 949-629-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1572720824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: