Healthcare Provider Details

I. General information

NPI: 1063421980
Provider Name (Legal Business Name): ROBERT CASTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CLARK AVE
LONG BEACH CA
90815-2521
US

IV. Provider business mailing address

PO BOX 1682
BELLFLOWER CA
90707-1682
US

V. Phone/Fax

Practice location:
  • Phone: 562-597-4181
  • Fax: 562-597-7083
Mailing address:
  • Phone: 562-229-9452
  • Fax: 562-920-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG62694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: