Healthcare Provider Details

I. General information

NPI: 1285154591
Provider Name (Legal Business Name): JACEY J CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NAPA VALLEY CORPORATE DR. BLDG B
NAPA CA
94558
US

IV. Provider business mailing address

2751 NAPA VALLEY CORPORATE DR BLDG B
NAPA CA
94558-6216
US

V. Phone/Fax

Practice location:
  • Phone: 707-227-3900
  • Fax:
Mailing address:
  • Phone: 707-227-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: