Healthcare Provider Details

I. General information

NPI: 1043827173
Provider Name (Legal Business Name): KEVIN CASTILLO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 BRISTOL ST STE B
COSTA MESA CA
92626-5997
US

IV. Provider business mailing address

2777 BRISTOL ST STE B
COSTA MESA CA
92626-5997
US

V. Phone/Fax

Practice location:
  • Phone: 949-250-1122
  • Fax:
Mailing address:
  • Phone: 561-395-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: