Provider Demographics
NPI:1881355980
Name:CASTILLO, ITSY
Entity type:Individual
Prefix:
First Name:ITSY
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ITSY
Other - Middle Name:
Other - Last Name:CASTILLO ROSALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTER NURSE
Mailing Address - Street 1:727 PENNSYLVANIA AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-1282
Mailing Address - Country:US
Mailing Address - Phone:917-402-6776
Mailing Address - Fax:
Practice Address - Street 1:1515 HANCOCK ST STE 203
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5230
Practice Address - Country:US
Practice Address - Phone:908-900-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-019418163W00000X
PR35515-A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse