Healthcare Provider Details

I. General information

NPI: 1730657537
Provider Name (Legal Business Name): NUBIA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14354 W ROANOKE AVE
GOODYEAR AZ
85395-1414
US

IV. Provider business mailing address

2025 N 3RD ST STE 250
PHOENIX AZ
85004-1472
US

V. Phone/Fax

Practice location:
  • Phone: 602-419-9011
  • Fax:
Mailing address:
  • Phone: 602-283-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: