Provider Demographics
NPI:1124860614
Name:CASTILLO, MA ROWENA (DPT)
Entity type:Individual
Prefix:
First Name:MA ROWENA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 FITZGERALD AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-0228
Mailing Address - Country:US
Mailing Address - Phone:805-216-6448
Mailing Address - Fax:
Practice Address - Street 1:874 FITZGERALD AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-0228
Practice Address - Country:US
Practice Address - Phone:805-216-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28682208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation