Provider Demographics
NPI:1104187178
Name:CASTILLO, MARISELA PATRICIA
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:PATRICIA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W 132ND ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3103
Mailing Address - Country:US
Mailing Address - Phone:347-515-1143
Mailing Address - Fax:
Practice Address - Street 1:45 W 132ND ST APT 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3103
Practice Address - Country:US
Practice Address - Phone:347-515-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator