Provider Demographics
NPI:1275090912
Name:CASTILLO, DENISSE ALEJANDRA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:DENISSE
Middle Name:ALEJANDRA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:DENISSE
Other - Middle Name:ALEJANDRA
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7904 GREENEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STA
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3170
Mailing Address - Country:US
Mailing Address - Phone:703-220-7882
Mailing Address - Fax:
Practice Address - Street 1:163 FORT EVANS RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4420
Practice Address - Country:US
Practice Address - Phone:703-443-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177348208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001236163OtherBOARD OF NURSING DEPARTMENT OF HEALTH PROFESSIONALS
VA0024177348OtherBOARD OF NURSING DEPARTMENT OF HEALTH PREFESSIONALS
201912307OtherPEDIATRIC NURSING CERTIFICATION BOARD