Provider Demographics
NPI:1164182143
Name:CASTILLO, EVELYN RENE
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:RENE
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 1:817 W STEVENS AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5024
Mailing Address - Country:US
Mailing Address - Phone:714-307-8366
Mailing Address - Fax:
Practice Address - Street 1:817 W STEVENS AVE APT 12
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-5024
Practice Address - Country:US
Practice Address - Phone:714-307-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst