Provider Demographics
NPI:1467177923
Name:CASTIGADORGAYOMALI, ERNEST (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:CASTIGADORGAYOMALI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:ERNEST
Other - Middle Name:
Other - Last Name:GAYOMALI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:16724 STAGS LEAP LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-6127
Mailing Address - Country:US
Mailing Address - Phone:951-258-4275
Mailing Address - Fax:
Practice Address - Street 1:16724 STAGS LEAP LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-6127
Practice Address - Country:US
Practice Address - Phone:951-258-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily