Provider Demographics
NPI:1295201309
Name:CASTILLO, DARYL R (RN)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:R
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6047 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2242
Mailing Address - Country:US
Mailing Address - Phone:312-859-8528
Mailing Address - Fax:312-803-1911
Practice Address - Street 1:1900 W. POLK STREET
Practice Address - Street 2:ADMINISTRATION BLDG. - ROOM 154
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-835-5765
Practice Address - Fax:312-864-9009
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.367843163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management