=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003068834
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHIL ORALLO CASTILLO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2008
-----------------------------------------------------
Last Update Date | 10/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 N STATE ST ROOM 14-901
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90033-1029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-226-4597
-----------------------------------------------------
Fax | 323-226-2794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 83 E COMMONWEALTH AVE UNIT 3D
-----------------------------------------------------
City | ALHAMBRA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91801-7905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-864-5988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | A80279
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------