Provider Demographics
NPI:1174356760
Name:CASTILLO, DAISY
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
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 1:1410 GABILAN DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5995
Mailing Address - Country:US
Mailing Address - Phone:831-313-6422
Mailing Address - Fax:
Practice Address - Street 1:1410 GABILAN DR APT 3
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5995
Practice Address - Country:US
Practice Address - Phone:831-313-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program