Provider Demographics
NPI:1801098132
Name:CASTILLO, JASMINE TABOADA (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:TABOADA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7160 DARBY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3122
Mailing Address - Country:US
Mailing Address - Phone:702-203-3450
Mailing Address - Fax:
Practice Address - Street 1:2890 BELCASTRO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3036
Practice Address - Country:US
Practice Address - Phone:702-203-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV005702029OtherJCR HOME CARE
NV005702678OtherDESERT INN RESIDENTIAL