Provider Demographics
NPI:1477267508
Name:HERNANDEZ CASTILLO, VANESSA S
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:S
Last Name:HERNANDEZ CASTILLO
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 1:511 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MO
Mailing Address - Zip Code:63435-1340
Mailing Address - Country:US
Mailing Address - Phone:714-906-4010
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE HILL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MO
Practice Address - Zip Code:63435
Practice Address - Country:US
Practice Address - Phone:573-288-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer