Healthcare Provider Details

I. General information

NPI: 1396654349
Provider Name (Legal Business Name): KELLY CASTILLO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 LINDA VISTA RD
SAN DIEGO CA
92111-6307
US

IV. Provider business mailing address

1061 LENREY AVE
EL CENTRO CA
92243-3820
US

V. Phone/Fax

Practice location:
  • Phone: 858-810-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number32735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: