Provider Demographics
NPI:1265717680
Name:CASTILLEJO, PRECIOSA (NP)
Entity type:Individual
Prefix:
First Name:PRECIOSA
Middle Name:
Last Name:CASTILLEJO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2967 HEIDI CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2718
Mailing Address - Country:US
Mailing Address - Phone:408-251-7589
Mailing Address - Fax:
Practice Address - Street 1:2880 STORY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-3942
Practice Address - Country:US
Practice Address - Phone:408-729-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily