Provider Demographics
NPI:1205034725
Name:CASTILLO, TERESITA E
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:E
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 1:14242 ROSCOE BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4251
Mailing Address - Country:US
Mailing Address - Phone:800-326-3254
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:44407 CHALLENGER WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3237
Practice Address - Country:US
Practice Address - Phone:661-341-3100
Practice Address - Fax:661-942-2305
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50448Medicaid