Healthcare Provider Details

I. General information

NPI: 1609509587
Provider Name (Legal Business Name): JULIO CESAR CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 BROOKHURST ST STE 101
GARDEN GROVE CA
92840-2865
US

IV. Provider business mailing address

PO BOX 919
FULLERTON CA
92836-0919
US

V. Phone/Fax

Practice location:
  • Phone: 714-296-1934
  • Fax:
Mailing address:
  • Phone: 714-680-9000
  • Fax: 714-680-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: