Healthcare Provider Details

I. General information

NPI: 1649430372
Provider Name (Legal Business Name): ADRIAN EDGARDO CASTRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 FOOTHILL BLVD SUITE 201
LA CANADA CA
91011-2122
US

IV. Provider business mailing address

1346 FOOTHILL BLVD SUITE 201
LA CANADA CA
91011-2122
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-5583
  • Fax: 818-790-9517
Mailing address:
  • Phone: 818-790-5583
  • Fax: 818-790-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA111530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: