Provider Demographics
NPI:1629720834
Name:CASTILLO, HARLENE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:HARLENE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 TUJUNGA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3061
Mailing Address - Country:US
Mailing Address - Phone:818-359-6594
Mailing Address - Fax:
Practice Address - Street 1:3006 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2536
Practice Address - Country:US
Practice Address - Phone:626-773-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018154363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology