Provider Demographics
NPI:1497149389
Name:CASTILLO, WENDY (LMT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2761 28TH AVE
Mailing Address - Street 2:APARTMENT C
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7815
Mailing Address - Country:US
Mailing Address - Phone:970-313-3394
Mailing Address - Fax:
Practice Address - Street 1:1517 16TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4574
Practice Address - Country:US
Practice Address - Phone:970-313-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0017102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist