Provider Demographics
NPI: | 1164521035 |
---|---|
Name: | CASTILLO, PETER A (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | PETER |
Middle Name: | A |
Last Name: | CASTILLO |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 15215 NATIONAL AVE STE 104 |
Mailing Address - Street 2: | |
Mailing Address - City: | LOS GATOS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95032-2425 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 925-905-9922 |
Mailing Address - Fax: | 925-905-9925 |
Practice Address - Street 1: | 15215 NATIONAL AVE STE 104 |
Practice Address - Street 2: | |
Practice Address - City: | LOS GATOS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95032-2425 |
Practice Address - Country: | US |
Practice Address - Phone: | 925-905-9922 |
Practice Address - Fax: | 925-905-9925 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-21 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME96973 | 207V00000X |
CA | A109681 | 207VF0040X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207VF0040X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | CP113X | Other | PTAN |