=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154824035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIO-INTERVENTIONAL SPECIALISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2018
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5562 PHILADELPHIA ST STE 200
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-2482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-464-9119
-----------------------------------------------------
Fax | 909-517-9218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5562 PHILADELPHIA ST STE 200
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-2482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-464-9119
-----------------------------------------------------
Fax | 909-517-9218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT M CASTRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 909-464-9119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 20A9770
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------