Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 61767 | MN |
N | 207N00000X | Dermatologist | A133196 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A133196 | CA |
NPI | 1497098644 |
---|---|
Provider Name | Dr. Jason Robert Castillo |
First Address | Irvine, CA 92604-4694 |
Second Address | Irvine, CA 92604-4694 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2013 |
Last Update Date | 03/12/2021 |