1487009965 NPI number — STEPHEN NATHAN CASTILLO M. ED, PPS

Table of content: STEPHEN NATHAN CASTILLO M. ED, PPS (NPI 1487009965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487009965 NPI number — STEPHEN NATHAN CASTILLO M. ED, PPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
STEPHEN
Provider Middle Name:
NATHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. ED, PPS
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:
1487009965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/19/2025
NPI Reactivation Date:
06/11/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41815 ROAD 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OROSI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93647-2008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-528-4731
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41815 ROAD 128
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROSI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93647-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-528-4731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2016

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: 101YM0800X , with the licence number:  220182371 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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