Provider Demographics
NPI:1255695193
Name:CASTILLO, CARLOS (SP ED TEACHER)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:SP ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 KEW GARDENS RD APT 4C
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1941
Mailing Address - Country:US
Mailing Address - Phone:191-765-1997
Mailing Address - Fax:
Practice Address - Street 1:13111 KEW GARDENS RD APT 4C
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1941
Practice Address - Country:US
Practice Address - Phone:191-765-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist