Provider Demographics
NPI:1619645546
Name:EUGENIO, MARIA CARMEN CASTILLO (OTR)
Entity Type:Individual
Prefix:
First Name:MARIA CARMEN
Middle Name:CASTILLO
Last Name:EUGENIO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 GLITHERO CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1604
Mailing Address - Country:US
Mailing Address - Phone:408-439-9122
Mailing Address - Fax:
Practice Address - Street 1:1023 GLITHERO CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1604
Practice Address - Country:US
Practice Address - Phone:408-439-9122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist