Provider Demographics
NPI:1255849584
Name:CASTILLO, CATHY (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935113 1/2 AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638
Mailing Address - Country:US
Mailing Address - Phone:831-710-6662
Mailing Address - Fax:
Practice Address - Street 1:2935113 1/2 AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638
Practice Address - Country:US
Practice Address - Phone:831-710-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2470A2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician