Provider Demographics
NPI:1033546726
Name:CASTILLO, ROBERT CONRAD
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CONRAD
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST MARINE SPECIAL OPERATIONS BATTALION
Mailing Address - Street 2:BLD. 4100377 CAMP PENDLETON
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:92055-5341
Mailing Address - Country:US
Mailing Address - Phone:760-725-6576
Mailing Address - Fax:
Practice Address - Street 1:1ST MARINE SPECIAL OPERATIONS BATTALION
Practice Address - Street 2:BLD. 4100377
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5341
Practice Address - Country:US
Practice Address - Phone:760-725-6576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8403OtherSPECIAL OPERATIONS INDEPENDENT DUTY CORPSMAN