Provider Demographics
NPI:1801658042
Name:CASTILLO, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 HONDO VALLEY PL SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8697
Mailing Address - Country:US
Mailing Address - Phone:505-243-2551
Mailing Address - Fax:505-243-0446
Practice Address - Street 1:1503 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1708
Practice Address - Country:US
Practice Address - Phone:505-243-2551
Practice Address - Fax:505-243-0446
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health