Provider Service Network, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVIDER SERVICE NETWORK, INC

Practice address

212 Bailey St Apt 204
Los Angeles, CA 90033-2460

Phone

(323) 264-5000

Fax

(323) 264-5003

NPI assigned

Jun 24, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Hector Raphael Castillo, MD

Title

Ceo

Phone

(323) 264-5000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1336700012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 BAILEY ST APT 204",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332460",
            "telephone_number": "323-264-5000",
            "fax_number": "323-264-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 BAILEY ST APT 204",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332460",
            "telephone_number": "323-264-5000",
            "fax_number": "323-264-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER SERVICE NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_middle_name": "RAPHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-264-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.