Provider Demographics
NPI:1033981436
Name:IGNACIO, MENCHU CASTILLO (AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MENCHU
Middle Name:CASTILLO
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 E BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7400
Mailing Address - Country:US
Mailing Address - Phone:626-221-3477
Mailing Address - Fax:
Practice Address - Street 1:1855 E BELMONT CT
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-7400
Practice Address - Country:US
Practice Address - Phone:626-221-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner