Provider Demographics
NPI:1346785946
Name:CASTILLO-FUENTES, SOFIA MARIE (RN, CLC)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:MARIE
Last Name:CASTILLO-FUENTES
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COUNTY ROAD 134
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-7709
Mailing Address - Country:US
Mailing Address - Phone:361-389-3447
Mailing Address - Fax:
Practice Address - Street 1:112 COUNTY ROAD 134
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-7709
Practice Address - Country:US
Practice Address - Phone:361-389-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX818520163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant