Healthcare Provider Details

I. General information

NPI: 1184845786
Provider Name (Legal Business Name): MARK SIDNEY CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HUERTA AVE
GREENFIELD CA
93927-5762
US

IV. Provider business mailing address

18225 HALE AVE
MORGAN HILL CA
95037-3547
US

V. Phone/Fax

Practice location:
  • Phone: 831-674-2180
  • Fax:
Mailing address:
  • Phone: 408-465-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: