Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003097817 |
---|---|
Provider Name | Juan Castillo JR. |
First Address | Fowler, CA 93625-2316 |
Second Address | Fowler, CA 93625-2316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 18/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101076 | MEDI-CAL (01) | CA |