Provider Demographics
NPI:1942680079
Name:RAUL A CASTILLO MD PC
Entity Type:Organization
Organization Name:RAUL A CASTILLO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-874-7014
Mailing Address - Street 1:PO BOX 7387
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-0013
Mailing Address - Country:US
Mailing Address - Phone:480-874-7014
Mailing Address - Fax:480-874-7015
Practice Address - Street 1:275 W 28TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7308
Practice Address - Country:US
Practice Address - Phone:928-329-5011
Practice Address - Fax:928-248-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26901207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty