Healthcare Provider Details

I. General information

NPI: 1316145261
Provider Name (Legal Business Name): MICHAEL PAUL CASTRO RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 CHERRY ST STE 100
LOS ALAMITOS CA
90720-2473
US

IV. Provider business mailing address

166 N MAGNOLIA AVE
MONROVIA CA
91016-2133
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-5600
  • Fax: 562-795-5602
Mailing address:
  • Phone: 626-675-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number545956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: