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NPI Code Detail

MEDICARE: RICHARD D DE CASTRO PA-C

MEDICARE: RICHARD D DE CASTRO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA19596CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA19596OTHERCASTATE

General Provider Information

NPI Number : 1295908861
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD D DE CASTRO PA-C
Provider Business Mailing Address
First Line : 2131 W 3RD ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-1901
Country : US
Telephone Number : 213-484-7781
Fax Number :
Provider Business Practice Location Address
First Line : 1850 SULLIVAN AVE
Second Line : SUITE 330
City : DALY CITY
State : CA
Zip : 94015-2223
Country : US
Telephone Number : 650-756-5630
Fax Number : 650-756-0136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2008
Last Update Date : 09/17/2010

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Directions to “ RICHARD D DE CASTRO PA-C” Practice Location

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