1114237724 NPI number — DR. RICHARD W. GASTIL PSYD, MSW, MFT, MA

Table of content: DR. RICHARD W. GASTIL PSYD, MSW, MFT, MA (NPI 1114237724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114237724 NPI number — DR. RICHARD W. GASTIL PSYD, MSW, MFT, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASTIL
Provider First Name:
RICHARD
Provider Middle Name:
W.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD, MSW, MFT, MA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GASTIL
Provider Other First Name:
RICHARD
Provider Other Middle Name:
WALTER
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
PSYD, MSW, MFT, MA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114237724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
746 E CHAPMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92866-1621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-324-2210
Provider Business Mailing Address Fax Number:
714-779-5300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
746 E CHAPMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92866-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-324-2210
Provider Business Practice Location Address Fax Number:
714-779-5300
Provider Enumeration Date:
10/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC27814 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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