Provider Demographics
NPI:1427583897
Name:CASTORILLO, ROSE RACHELLE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:RACHELLE
Last Name:CASTORILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N GRAND AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1712
Mailing Address - Country:US
Mailing Address - Phone:626-409-8752
Mailing Address - Fax:
Practice Address - Street 1:200 N GRAND AVE APT 104
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1712
Practice Address - Country:US
Practice Address - Phone:626-409-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst