Provider Demographics
NPI:1285147520
Name:CASTILLO, VANDER C (MA ATC CES CEAS)
Entity type:Individual
Prefix:MR
First Name:VANDER
Middle Name:C
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MA ATC CES CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 ONYX ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2742
Mailing Address - Country:US
Mailing Address - Phone:310-999-2395
Mailing Address - Fax:
Practice Address - Street 1:5004 ONYX ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2742
Practice Address - Country:US
Practice Address - Phone:424-999-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer