Healthcare Provider Details

I. General information

NPI: 1306834338
Provider Name (Legal Business Name): MICHAEL P CASTRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 VENICE BLVD APT 402
LOS ANGELES CA
90034-7439
US

IV. Provider business mailing address

8900 WILSHIRE BLVD
BEVERLY HILLS CA
90211-1958
US

V. Phone/Fax

Practice location:
  • Phone: 808-445-4085
  • Fax: 866-438-4310
Mailing address:
  • Phone: 310-432-8900
  • Fax: 310-432-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number174662
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number15323
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number144118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: