Provider Demographics
NPI:1396432084
Name:CASTILLO, JAZMINE MARTHA NICOLE DAWN
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:MARTHA NICOLE DAWN
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 1:583 N 350 W
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-9703
Mailing Address - Country:US
Mailing Address - Phone:317-364-8259
Mailing Address - Fax:
Practice Address - Street 1:583 N 350 W
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-9703
Practice Address - Country:US
Practice Address - Phone:317-364-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician