Provider Demographics
NPI:1689960577
Name:CASTILLO, ROSITA
Entity Type:Individual
Prefix:MS
First Name:ROSITA
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:HCR 79 BOX 1510
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NM
Mailing Address - Zip Code:87013
Mailing Address - Country:US
Mailing Address - Phone:505-731-1505
Mailing Address - Fax:505-731-1502
Practice Address - Street 1:HC 79 BOX 1510
Practice Address - Street 2:
Practice Address - City:OJO ENCINO
Practice Address - State:NM
Practice Address - Zip Code:87013-9612
Practice Address - Country:US
Practice Address - Phone:505-731-1505
Practice Address - Fax:505-731-1502
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006084101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM198284OtherMANAGER HEALTH SYSTEM