Provider Demographics
NPI:1083691778
Name:CASTILLO, ROMEO C (MD)
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:C
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1524 W LACEY BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5965
Mailing Address - Country:US
Mailing Address - Phone:559-853-4660
Mailing Address - Fax:559-583-4685
Practice Address - Street 1:1524 W LACEY BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5965
Practice Address - Country:US
Practice Address - Phone:559-853-4660
Practice Address - Fax:559-583-4685
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83587OtherCALIF. LICENSE
00A835871Medicare PIN
CAA83587OtherCALIF. LICENSE