Healthcare Provider Details

I. General information

NPI: 1063784957
Provider Name (Legal Business Name): DAVID CASTILLO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 UNIVERSITY AVE
SAN DIEGO CA
92103-3007
US

IV. Provider business mailing address

120 UNIVERSITY AVE
SAN DIEGO CA
92103-3007
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-1010
  • Fax: 619-260-1031
Mailing address:
  • Phone: 619-260-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number66898
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18159
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: