Provider Demographics
NPI:1841939956
Name:CASTILLO, EVELINA (AOD)
Entity type:Individual
Prefix:MISS
First Name:EVELINA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:AOD
Other - Prefix:MISS
Other - First Name:EVELINA
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:197 W WHITTAKER WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2130
Mailing Address - Country:US
Mailing Address - Phone:559-280-7165
Mailing Address - Fax:
Practice Address - Street 1:1235 E ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2024
Practice Address - Country:US
Practice Address - Phone:559-268-6261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14387-RAC101YA0400X
CA00796754376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No376K00000XNursing Service Related ProvidersNurse's Aide