Provider Demographics
NPI:1396497012
Name:CASTILLO, JOSHUA LUIS (LAC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LUIS
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 SE ALDER
Mailing Address - Street 2:APARTMENT 7
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214
Mailing Address - Country:US
Mailing Address - Phone:469-514-4966
Mailing Address - Fax:
Practice Address - Street 1:3059 SE ALDER ST APT 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2593
Practice Address - Country:US
Practice Address - Phone:469-514-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist