Provider Demographics
NPI:1245945203
Name:PRACTICALMED INC
Entity type:Organization
Organization Name:PRACTICALMED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAUSTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-979-9404
Mailing Address - Street 1:5405 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5156
Mailing Address - Country:US
Mailing Address - Phone:559-556-5591
Mailing Address - Fax:888-720-1716
Practice Address - Street 1:5405 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5156
Practice Address - Country:US
Practice Address - Phone:559-556-5591
Practice Address - Fax:888-720-1716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRACTICALMED, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-13
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty