Provider Demographics
NPI:1689984320
Name:CASTRO, RODOLFO PERNIA (NP)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:PERNIA
Last Name:CASTRO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 WEST DRYDEN ST.
Mailing Address - Street 2:APT 204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3303
Mailing Address - Country:US
Mailing Address - Phone:626-839-9100
Mailing Address - Fax:626-839-9106
Practice Address - Street 1:1523 EAST AMAR ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1619
Practice Address - Country:US
Practice Address - Phone:626-839-9100
Practice Address - Fax:626-839-9106
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily