Healthcare Provider Details

I. General information

NPI: 1265772800
Provider Name (Legal Business Name): CYNTHIA CONCEPCION CASTILLON CADAC II - CA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 KEMPER ST
SAN DIEGO CA
92110-4906
US

IV. Provider business mailing address

3340 KEMPER ST
SAN DIEGO CA
92110-4906
US

V. Phone/Fax

Practice location:
  • Phone: 619-523-8121
  • Fax: 619-523-8742
Mailing address:
  • Phone: 619-523-8121
  • Fax: 619-523-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: