Stephanie Castillo, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

A159673 Issued in CA

Practice address

1601 Precision Park LN
San Ysidro, CA 92173-1345

Phone

(619) 662-4100

NPI assigned

Apr 18, 2017

Last updated

Aug 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centro de Salud de la Comunidad de San Ysidro,Inc.Group PAC ID 6901709435, 291 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Precision Park

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment Care Compare group NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  dba San Ysidro Health Senior Dental Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Otay

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1922051812
  NPD

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1902330723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921731345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7060 Clairemont Mesa Blvd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921111003",
            "country_code": "US",
            "telephone_number": "213-304-0326",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Msc Dept Of Family Medicine 1 University Of New Mexico",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871311003",
            "country_code": "US",
            "telephone_number": "505-272-6607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTILLO",
        "first_name": "STEPHANIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-18",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CA",
            "license": "A159673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlos Carriedo, DO
• Gabriela Alessandra Casagrande
• Margarita Castellanos Palazuelos
• Graciela Castellanos, MA IN MFT
• Clarissa A Castillo, PA
• Carolina Castro
• Amanda Racheal Cave, AMFT
• Centro de Salud de la Communidad de San Ysidro, Inc (San Ysidro Health Mobile Health Services 1G)
• Centro de Salud de la Comunidad de San Ysidro Inc (San Ysidro Health San Ysidro Health Center)
• Centro de Salud de la Comunidad de San Ysidro Inc (San Ysidro Health Maternal & Child Health Center)

• Addiction Medicine (Family Medicine) Physician in San Ysidro, CA
• Providers in San Ysidro, CA by specialty
• Addiction Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.