Healthcare Provider Details

I. General information

NPI: 1295586055
Provider Name (Legal Business Name): PATRICK CASTILLO MSOT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 HAWK LN
PALMDALE CA
93551-3618
US

IV. Provider business mailing address

217 HAWK LN
PALMDALE CA
93551-3618
US

V. Phone/Fax

Practice location:
  • Phone: 661-674-6007
  • Fax:
Mailing address:
  • Phone: 661-674-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK KELLY CASTILLO
Title or Position: CEO
Credential: MSOT
Phone: 661-674-6007