Healthcare Provider Details

I. General information

NPI: 1194002477
Provider Name (Legal Business Name): JOELLA MARGARITA CASTILLO D.C., C.C.S.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4167 26TH ST
SAN FRANCISCO CA
94131-1914
US

IV. Provider business mailing address

4104 24TH ST 295
SAN FRANCISCO CA
94114-3615
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-4892
  • Fax: 415-641-1327
Mailing address:
  • Phone: 415-641-4892
  • Fax: 415-641-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number22305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: