Provider Demographics
NPI:1659556058
Name:CLINICA DEL DR. CASTILLO Y DR. SILVA, INC..
Entity Type:Organization
Organization Name:CLINICA DEL DR. CASTILLO Y DR. SILVA, INC..
Other - Org Name:CLINICA DEL DR CASTILLO Y DR SILVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-493-1788
Mailing Address - Street 1:212 BAILEY STREET
Mailing Address - Street 2:STE 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-264-5000
Mailing Address - Fax:323-264-5003
Practice Address - Street 1:212 BAILEY STREET
Practice Address - Street 2:STE 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-264-5000
Practice Address - Fax:323-264-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A761580Medicaid
CAW22132Medicare PIN
CA00A761580Medicaid
CAA76158Medicare PIN
CAA69892Medicare PIN