Provider Demographics
NPI:1841018660
Name:CASTILLO-MANZO, UNIQUE
Entity type:Individual
Prefix:
First Name:UNIQUE
Middle Name:
Last Name:CASTILLO-MANZO
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 1:7804 RAINWATER RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-8390
Mailing Address - Country:US
Mailing Address - Phone:505-721-8478
Mailing Address - Fax:
Practice Address - Street 1:7804 RAINWATER RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-8390
Practice Address - Country:US
Practice Address - Phone:505-721-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician