Provider Demographics
NPI:1497322465
Name:CASTILLO, HERMINIA ARGUMANIZ (RDA)
Entity Type:Individual
Prefix:
First Name:HERMINIA
Middle Name:ARGUMANIZ
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 ATLANTIC BLVD UNIT 212
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-2988
Mailing Address - Country:US
Mailing Address - Phone:323-684-4891
Mailing Address - Fax:
Practice Address - Street 1:9050 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2410
Practice Address - Country:US
Practice Address - Phone:562-456-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA74133126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDA74133Medicaid