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General NPI Number Information
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NPI Number | 1790990265
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Entity Type | Individual
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Provider Name | BENJAMIN CASTILLO MADRID JR. OTRL
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 12/06/2008
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Provider Practice Location Address
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Address Line | 1200 N STATE ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1029
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Country | US
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Telephone | 213-226-7437
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 AGATE ST APT D
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2314
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Country | US
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Telephone | 310-508-0624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2240
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License Number State | CA
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