Individual provider Active NPI

Juan Castillo Jr.

  • Addiction (Substance Use Disorder) Counselor
  • Fowler, CA
National Provider Identifier
1003097817
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
C060460819 Issued in CA
Practice address
311 E Merced St
Fowler, CA 93625-2316
Phone
(559) 892-9452
NPI assigned
Nov 20, 2007
Last updated
Dec 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X C060460819 CA Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X

Addresses

Primary practice location

311 E Merced St
Fowler, CA 93625-2316

Mailing address

311 E Merced St
Fowler, CA 93625-2316
Phone (559) 892-9452

Other practice location 1

701 E Main St
Fowler, CA 93625-2499
Phone (559) 834-6160

Other practice location 2

975 E Adams Ave
Fowler, CA 93625-2702
Phone (559) 834-6098

Other identifiers 1

IdentifierTypeStateIssuer
101076OtherCAMEDI-CAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
C060460819CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Prodigy Healthcare Non Profit CurrentSince Oct 23, 2022 Accepting new patients
Prodigy Healthcare Inc. Addiction (Substance Use Disorder) PastSince Sep 25, 2019 Accepting new patients

Locations

311 E Merced St
Fowler, CA 93625
Phone (555) 892-9452

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1003097817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 E MERCED ST",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "936252316",
            "telephone_number": "559-892-9452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 E MERCED ST",
            "city": "FOWLER",
            "state": "CA",
            "postal_code": "936252316",
            "telephone_number": "559-892-9452"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 E Main St",
            "address_purpose": "LOCATION",
            "city": "Fowler",
            "state": "CA",
            "postal_code": "936252499",
            "country_code": "US",
            "telephone_number": "559-834-6160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "975 E Adams Ave",
            "address_purpose": "LOCATION",
            "city": "Fowler",
            "state": "CA",
            "postal_code": "936252702",
            "country_code": "US",
            "telephone_number": "559-834-6098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTILLO",
        "first_name": "JUAN",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-20",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "C060460819",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "101076",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fowler, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.