Provider Demographics
NPI:1255191995
Name:CASTILLO-CAMPA, HERENDIRA GUADALUPE
Entity type:Individual
Prefix:
First Name:HERENDIRA
Middle Name:GUADALUPE
Last Name:CASTILLO-CAMPA
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 1:50 35TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-2100
Mailing Address - Country:US
Mailing Address - Phone:616-776-5110
Mailing Address - Fax:
Practice Address - Street 1:50 35TH ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-2100
Practice Address - Country:US
Practice Address - Phone:616-776-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker