Healthcare Provider Details

I. General information

NPI: 1124336953
Provider Name (Legal Business Name): RUDOLFO CASTRO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 02/23/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 WILSHIRE BLVD
LOS ANGELES CA
90010-3512
US

IV. Provider business mailing address

PO BOX 3102
LANDERS CA
92285-0102
US

V. Phone/Fax

Practice location:
  • Phone: 213-677-7005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW99038
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: