Provider Demographics
NPI:1598207573
Name:CASTRO, JESUS MANUEL JR (CCAPP C053520518)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MANUEL
Last Name:CASTRO
Suffix:JR
Gender:M
Credentials:CCAPP C053520518
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 BIGGS CT
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-8101
Mailing Address - Country:US
Mailing Address - Phone:619-813-7851
Mailing Address - Fax:
Practice Address - Street 1:1155 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-498-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC053520518101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)