Provider Demographics
NPI:1245424811
Name:CASTILLO, BLAKE MITCHELL (HS)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:MITCHELL
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ARCHIBALD CT
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2133
Mailing Address - Country:US
Mailing Address - Phone:909-580-0793
Mailing Address - Fax:
Practice Address - Street 1:451 ARCHIBALD CT
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2133
Practice Address - Country:US
Practice Address - Phone:909-580-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other