1285777813 NPI number — ROBERT M CASTRO DO

Table of content: ROBERT M CASTRO DO (NPI 1285777813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285777813 NPI number — ROBERT M CASTRO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTRO
Provider First Name:
ROBERT
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285777813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1358 PIERRE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91789-4476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-765-7297
Provider Business Mailing Address Fax Number:
877-991-4809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2621 S BRISTOL ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92704-5766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-754-1684
Provider Business Practice Location Address Fax Number:
714-966-0417
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A9770 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 20A9770 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00AX97700 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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