Provider Demographics
NPI:1801903729
Name:CASTILLO, EILEEN COLOMA (NP)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:COLOMA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3-3420 KUHIO HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1042
Mailing Address - Country:US
Mailing Address - Phone:808-245-1547
Mailing Address - Fax:808-246-1391
Practice Address - Street 1:3-3420 KUHIO HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1042
Practice Address - Country:US
Practice Address - Phone:808-245-1547
Practice Address - Fax:808-246-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN590339Medicaid
CA13012OtherNP LICENSE
CABM771ZMedicare PIN
CA13012OtherNP LICENSE