Healthcare Provider Details

I. General information

NPI: 1841939956
Provider Name (Legal Business Name): EVELINA CASTILLO AOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS EVELINA CASTILLO

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E ST
FRESNO CA
93706-2024
US

IV. Provider business mailing address

197 W WHITTAKER WAY
DINUBA CA
93618-2130
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-6261
  • Fax:
Mailing address:
  • Phone: 559-280-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14387-RAC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: