Healthcare Provider Details

I. General information

NPI: 1124984745
Provider Name (Legal Business Name): MELISSA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

536 TERRILL AVE
LOS ANGELES CA
90042-4934
US

V. Phone/Fax

Practice location:
  • Phone: 323-378-9641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: