Healthcare Provider Details

I. General information

NPI: 1659366136
Provider Name (Legal Business Name): HECTOR CASTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E WASHINGTON BLVD
LOS ANGELES CA
90021-3020
US

IV. Provider business mailing address

1005 E WASHINGTON BLVD
LOS ANGELES CA
90021-3020
US

V. Phone/Fax

Practice location:
  • Phone: 213-745-3636
  • Fax: 213-745-3626
Mailing address:
  • Phone: 213-745-3636
  • Fax: 213-745-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA76158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: