Healthcare Provider Details

I. General information

NPI: 1578737995
Provider Name (Legal Business Name): VERONICA CASTILLO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15115 AMAR RD
LA PUENTE CA
91744-1914
US

IV. Provider business mailing address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

V. Phone/Fax

Practice location:
  • Phone: 626-918-4700
  • Fax:
Mailing address:
  • Phone: 323-644-3880
  • Fax: 323-644-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: