Healthcare Provider Details

I. General information

NPI: 1356196653
Provider Name (Legal Business Name): JORDAN RAIN CASTELLO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDAN RAIN CASTELLO PA-C

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 VISTA WAY
OCEANSIDE CA
92056-4506
US

IV. Provider business mailing address

4002 VISTA WAY
OCEANSIDE CA
92056-4506
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-8411
  • Fax:
Mailing address:
  • Phone: 951-345-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: