Healthcare Provider Details

I. General information

NPI: 1427414598
Provider Name (Legal Business Name): RAYMOND CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 N JOHNSON AVE STE 111
EL CAJON CA
92020-1649
US

IV. Provider business mailing address

1365 N JOHNSON AVE STE 111
EL CAJON CA
92020-1649
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-4801
  • Fax: 619-442-1592
Mailing address:
  • Phone: 619-440-4801
  • Fax: 619-442-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: