Provider Demographics
NPI:1720262306
Name:CASTILLO, PATRICIA ADRIELA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ADRIELA
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 1:1295 W STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2881
Mailing Address - Country:US
Mailing Address - Phone:760-353-0763
Mailing Address - Fax:
Practice Address - Street 1:1295 W STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2881
Practice Address - Country:US
Practice Address - Phone:760-353-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor