Provider Demographics
NPI:1205203049
Name:CASTILLO, OLGA OLIVIA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:OLIVIA
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 1:1620 CUMMINGS RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358
Mailing Address - Country:US
Mailing Address - Phone:209-491-0627
Mailing Address - Fax:902-622-1420
Practice Address - Street 1:1620 CUMMINGS RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358
Practice Address - Country:US
Practice Address - Phone:209-491-0627
Practice Address - Fax:902-622-1420
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator