Provider Demographics
NPI:1780212092
Name:DE CASTRO, MARK CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:DE CASTRO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24671 MONROE AVE STE C102
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9589
Mailing Address - Country:US
Mailing Address - Phone:951-200-3620
Mailing Address - Fax:951-200-5811
Practice Address - Street 1:215 S HICKORY ST STE 112
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4360
Practice Address - Country:US
Practice Address - Phone:760-737-8460
Practice Address - Fax:760-739-5669
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist