Provider Demographics
NPI:1013231000
Name:CASTILLO, DENNIS JR (BA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:CASTILLO
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21810 NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-783-4677
Mailing Address - Fax:213-252-5870
Practice Address - Street 1:19700 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1100
Practice Address - Country:US
Practice Address - Phone:310-783-4677
Practice Address - Fax:213-252-5870
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker