Provider Demographics
NPI:1164180246
Name:PINKY CASTILLO DBA
Entity Type:Organization
Organization Name:PINKY CASTILLO DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PINKY
Authorized Official - Middle Name:ROXAS
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-220-4599
Mailing Address - Street 1:5520 W WESTERN STAR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-1215
Mailing Address - Country:US
Mailing Address - Phone:720-220-4599
Mailing Address - Fax:
Practice Address - Street 1:5520 W WESTERN STAR BLVD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-1215
Practice Address - Country:US
Practice Address - Phone:720-220-4599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health