Provider Demographics
NPI:1083887186
Name:TONY CASTILLO
Entity Type:Organization
Organization Name:TONY CASTILLO
Other - Org Name:SADDLEBACK PORTABLE X-RAY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:BS CRT ARRT (R)
Authorized Official - Phone:714-835-2915
Mailing Address - Street 1:PO BOX 4427
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92702-4427
Mailing Address - Country:US
Mailing Address - Phone:714-835-2915
Mailing Address - Fax:714-543-3114
Practice Address - Street 1:1651 E 4TH ST
Practice Address - Street 2:SUITE # 212
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5164
Practice Address - Country:US
Practice Address - Phone:714-835-2915
Practice Address - Fax:714-543-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR059846AMedicare PIN