Provider Demographics
NPI:1780454561
Name:CASTILLO, ALLYSSA LORIAN (DNP)
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:LORIAN
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LOCKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7402
Mailing Address - Country:US
Mailing Address - Phone:512-214-9946
Mailing Address - Fax:
Practice Address - Street 1:4751 HAMILTON WOLFE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3458
Practice Address - Country:US
Practice Address - Phone:210-253-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139450363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology