Healthcare Provider Details

I. General information

NPI: 1164521035
Provider Name (Legal Business Name): PETER A. CASTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 NATIONAL AVE STE 104
LOS GATOS CA
95032-2425
US

IV. Provider business mailing address

15215 NATIONAL AVE STE 104
LOS GATOS CA
95032-2425
US

V. Phone/Fax

Practice location:
  • Phone: 925-905-9922
  • Fax: 925-905-9925
Mailing address:
  • Phone: 925-905-9922
  • Fax: 925-905-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME96973
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA109681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: