Provider Demographics
NPI:1922464163
Name:CASTILLO, NICOLE E (CSA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11118 BENEVOLENT WAY
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-7004
Mailing Address - Country:US
Mailing Address - Phone:281-690-6678
Mailing Address - Fax:
Practice Address - Street 1:11118 BENEVOLENT WAY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-7004
Practice Address - Country:US
Practice Address - Phone:281-690-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant