Provider Demographics
NPI:1174721450
Name:CASTILLO, VIVIAN D (PT)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:D
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:283 N RAMPART ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1852
Mailing Address - Country:US
Mailing Address - Phone:714-939-9300
Mailing Address - Fax:888-702-7969
Practice Address - Street 1:283 N RAMPART ST
Practice Address - Street 2:SUITE E
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1852
Practice Address - Country:US
Practice Address - Phone:714-939-9300
Practice Address - Fax:888-702-7969
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist