Provider Demographics
NPI:1073996146
Name:MIRANDA-CASTILLO, PHYLLIS (MSN)
Entity Type:Individual
Prefix:MISS
First Name:PHYLLIS
Middle Name:
Last Name:MIRANDA-CASTILLO
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 KYLE STEWART CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1302
Mailing Address - Country:US
Mailing Address - Phone:702-523-0924
Mailing Address - Fax:
Practice Address - Street 1:6737 KYLE STEWART CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1302
Practice Address - Country:US
Practice Address - Phone:702-523-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner