Provider Demographics
NPI:1912759077
Name:CASTILLO, PETER MICHAEL (LVN)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 FIRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4890
Mailing Address - Country:US
Mailing Address - Phone:661-586-3855
Mailing Address - Fax:
Practice Address - Street 1:6700 EUCALYPTUS DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-6075
Practice Address - Country:US
Practice Address - Phone:661-363-5947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN242241164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse