Provider Demographics
NPI:1780115972
Name:CASTILLO MAIRENA, FAUSTO J (MD)
Entity type:Individual
Prefix:DR
First Name:FAUSTO J
Middle Name:
Last Name:CASTILLO MAIRENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:559-863-0115
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
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA163451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty