Provider Demographics
NPI:1609908250
Name:CASTILLO-EDDY, DIANA XIMENA (MS)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:XIMENA
Last Name:CASTILLO-EDDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:DIANA
Other - Middle Name:XIMENA
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 1854
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077
Mailing Address - Country:US
Mailing Address - Phone:626-375-7224
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4262
Practice Address - Country:US
Practice Address - Phone:626-375-7224
Practice Address - Fax:818-484-8177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist