Provider Demographics
NPI:1134375009
Name:CASTILLO, VONDA SUE
Entity type:Individual
Prefix:
First Name:VONDA
Middle Name:SUE
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 1:21705 E ARROYO VERDE DR STE 238
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5773
Mailing Address - Country:US
Mailing Address - Phone:480-219-3953
Mailing Address - Fax:
Practice Address - Street 1:4100 S LINDSAY RD STE 113
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1507
Practice Address - Country:US
Practice Address - Phone:480-219-3953
Practice Address - Fax:480-219-4203
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-005134224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant