Provider Demographics
NPI:1912502246
Name:CASTILLO, DIANA K
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:CASTILLO
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 1:402 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3519
Mailing Address - Country:US
Mailing Address - Phone:701-301-2500
Mailing Address - Fax:
Practice Address - Street 1:402 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3519
Practice Address - Country:US
Practice Address - Phone:701-301-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant