Healthcare Provider Details

I. General information

NPI: 1083270813
Provider Name (Legal Business Name): LUIS J CASTILLO- REXACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NAPA VALLEY CORPORATE DR
NAPA CA
94558-6216
US

IV. Provider business mailing address

2751 NAPA VALLEY CORPORATE DR
NAPA CA
94558-6216
US

V. Phone/Fax

Practice location:
  • Phone: 707-259-8659
  • Fax:
Mailing address:
  • Phone: 707-299-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: