Provider Demographics
NPI:1609295005
Name:CASTILLO, EUPORIA
Entity Type:Individual
Prefix:
First Name:EUPORIA
Middle Name:
Last Name: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 1:6530 ANNIE OAKLEY DR APT 2522
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2176
Mailing Address - Country:US
Mailing Address - Phone:909-244-8649
Mailing Address - Fax:
Practice Address - Street 1:2904 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5015
Practice Address - Country:US
Practice Address - Phone:702-292-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1704528621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health