Healthcare Provider Details

I. General information

NPI: 1225630197
Provider Name (Legal Business Name): CESAR CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PACIFIC HWY STE 166
SAN DIEGO CA
92101-2422
US

IV. Provider business mailing address

1520 E 14TH ST
NATIONAL CITY CA
91950-4921
US

V. Phone/Fax

Practice location:
  • Phone: 619-616-1559
  • Fax:
Mailing address:
  • Phone: 619-616-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021196
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95201992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: