Provider Demographics
NPI:1609416908
Name:CASTILLO JIMENEZ, KATERINE M
Entity Type:Individual
Prefix:
First Name:KATERINE
Middle Name:M
Last Name:CASTILLO JIMENEZ
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 1:422 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-2326
Mailing Address - Country:US
Mailing Address - Phone:973-330-6754
Mailing Address - Fax:
Practice Address - Street 1:422 E 24TH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-2326
Practice Address - Country:US
Practice Address - Phone:973-330-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJP9R4Z2B3246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy