Provider Demographics
NPI:1346896693
Name:CASTILLO RODRIGUEZ, JOHNNY MANUEL
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:MANUEL
Last Name:CASTILLO RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3578 DEKALB AVE APT 5F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1179
Mailing Address - Country:US
Mailing Address - Phone:347-739-4399
Mailing Address - Fax:
Practice Address - Street 1:3578 DEKALB AVE APT 5F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1179
Practice Address - Country:US
Practice Address - Phone:347-739-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator