Provider Demographics
NPI:1366718744
Name:CASTILLA, MICHAEL RAMY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAMY
Last Name:CASTILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 HEGENBERGER RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-1420
Mailing Address - Country:US
Mailing Address - Phone:516-353-7093
Mailing Address - Fax:
Practice Address - Street 1:333 HEGENBERGER RD
Practice Address - Street 2:SUITE 600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1420
Practice Address - Country:US
Practice Address - Phone:516-353-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker