Provider Demographics
NPI:1952773350
Name:CASTILLO, MARILYN A
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:A
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 1:99-349 AHEAHE ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3510
Mailing Address - Country:US
Mailing Address - Phone:808-389-5634
Mailing Address - Fax:808-485-8920
Practice Address - Street 1:99-349 AHEAHE ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3510
Practice Address - Country:US
Practice Address - Phone:808-389-5634
Practice Address - Fax:808-485-8920
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-24
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1589707311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000333963OtherHMSA