Provider Demographics
NPI:1225533136
Name:CASTILLO, RAFAEL EDUARDO
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 HABITAT DR APT 2052
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3235
Mailing Address - Country:US
Mailing Address - Phone:720-281-6378
Mailing Address - Fax:
Practice Address - Street 1:6200 HABITAT DR APT 2052
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3235
Practice Address - Country:US
Practice Address - Phone:720-281-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-25
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X, 363AS0400X
CO363AS0400X
CO18107246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical