Provider Demographics
NPI:1346859162
Name:CASTILLO, ABRAHAM J (MC14599)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:J
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MC14599
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 44TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1104
Mailing Address - Country:US
Mailing Address - Phone:253-334-5440
Mailing Address - Fax:
Practice Address - Street 1:5436 44TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1104
Practice Address - Country:US
Practice Address - Phone:253-334-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603124373171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter