Healthcare Provider Details

I. General information

NPI: 1063361244
Provider Name (Legal Business Name): JEFFREY CASTILLO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 N ORANGE GROVE AVE STE 202
POMONA CA
91767-3042
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-8796
  • Fax: 909-623-3076
Mailing address:
  • Phone: 909-398-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: