Healthcare Provider Details

I. General information

NPI: 1487384160
Provider Name (Legal Business Name): JOHN REYNALDO CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 ROUTE 152
LAVALETTE WV
25535-9702
US

IV. Provider business mailing address

1448 10TH AVE STE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-697-9480
  • Fax: 304-697-9491
Mailing address:
  • Phone: 304-733-8728
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number36636
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36636
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: