Provider Demographics
NPI:1063839389
Name:CASTILLO, MA YVONNE RELAMPAGOS (RN)
Entity Type:Individual
Prefix:
First Name:MA YVONNE
Middle Name:RELAMPAGOS
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MA YVONNE
Other - Middle Name:BANO
Other - Last Name:RELAMPAGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5819 W PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3112
Mailing Address - Country:US
Mailing Address - Phone:623-792-0021
Mailing Address - Fax:
Practice Address - Street 1:5102 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1703
Practice Address - Country:US
Practice Address - Phone:623-848-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282NC0060X282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access