Healthcare Provider Details

I. General information

NPI: 1306211263
Provider Name (Legal Business Name): NOE FERNANDO RODRIGUEZ CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N JOHNSON AVE STE P
EL CAJON CA
92020-2589
US

IV. Provider business mailing address

700 N JOHNSON AVE STE P
EL CAJON CA
92020-2589
US

V. Phone/Fax

Practice location:
  • Phone: 619-441-1907
  • Fax: 619-441-1908
Mailing address:
  • Phone: 619-441-1907
  • Fax: 619-441-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-KLHQAE
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW139049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: