Healthcare Provider Details

I. General information

NPI: 1417437906
Provider Name (Legal Business Name): BONIFACIO CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

15901 AURORA CREST DR
WHITTIER CA
90605-1357
US

V. Phone/Fax

Practice location:
  • Phone: 562-325-5238
  • Fax:
Mailing address:
  • Phone: 562-500-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRCP91
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: