Provider Demographics
NPI:1316033244
Name:CASTILLO, MANUEL MONTILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:MONTILLA
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 1:591 CAMINO DE LA REINA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3102
Mailing Address - Country:US
Mailing Address - Phone:619-325-8748
Mailing Address - Fax:619-325-8732
Practice Address - Street 1:555 EAST VALLEY PARKWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-739-3030
Practice Address - Fax:760-739-2604
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42547207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C425470Medicaid
CAF00855Medicare UPIN
CAWC42547AMedicare ID - Type Unspecified
CA00C425470Medicaid