Healthcare Provider Details

I. General information

NPI: 1306035704
Provider Name (Legal Business Name): XAVIER ASTOLFO GOMEZ CASTILLO M.A., CCHT.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7856 E CREST CIR
LONG BEACH CA
90808-3107
US

IV. Provider business mailing address

7856 E CREST CIR
LONG BEACH CA
90808-3107
US

V. Phone/Fax

Practice location:
  • Phone: 323-905-4262
  • Fax:
Mailing address:
  • Phone: 323-905-4262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114440
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: