Provider Demographics
NPI:1205610854
Name:CASTILLO, JOSHUA BRYAN
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:BRYAN
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5357
Mailing Address - Country:US
Mailing Address - Phone:909-787-7147
Mailing Address - Fax:
Practice Address - Street 1:612 PINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5357
Practice Address - Country:US
Practice Address - Phone:909-787-7147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8710600722081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine