Provider Demographics
NPI:1891557138
Name:CASTRO, ROLANDO (PT)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ROLAND
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3633 VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4568
Mailing Address - Country:US
Mailing Address - Phone:760-729-7298
Mailing Address - Fax:
Practice Address - Street 1:1030 LA BONITA DR STE 240
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5267
Practice Address - Country:US
Practice Address - Phone:760-878-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist