Healthcare Provider Details

I. General information

NPI: 1346157948
Provider Name (Legal Business Name): MS. CAMILA ITZEL CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 CAMINO LITO GALINDO
RIO RICO AZ
85648
US

IV. Provider business mailing address

570 CAMINO LITO GALINDO
RIO RICO AZ
85648
US

V. Phone/Fax

Practice location:
  • Phone: 520-373-8700
  • Fax:
Mailing address:
  • Phone: 520-281-8282
  • Fax: 520-281-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17819
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: