Provider Demographics
NPI:1023550795
Name:CASTILLO, ERICK
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:CASTILLO
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:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-0546
Mailing Address - Country:US
Mailing Address - Phone:312-282-7430
Mailing Address - Fax:312-561-6551
Practice Address - Street 1:2703 S RINCON DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5662
Practice Address - Country:US
Practice Address - Phone:312-282-7430
Practice Address - Fax:312-561-6551
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ655393171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor