Provider Demographics
NPI:1912316977
Name:CASTILLO, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
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 1:1615 E 17TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8529
Mailing Address - Country:US
Mailing Address - Phone:714-955-4042
Mailing Address - Fax:714-541-7924
Practice Address - Street 1:3350 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-4620
Practice Address - Country:US
Practice Address - Phone:562-424-1869
Practice Address - Fax:562-683-2686
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator