Healthcare Provider Details

I. General information

NPI: 1053654160
Provider Name (Legal Business Name): CYNTHIA MARIE CASTILLO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 CESAR E.CHAVEZ
LOS ANGELES CA
90012
US

IV. Provider business mailing address

701 W CESAR E CHAVEZ AVE
LOS ANGELES CA
90012-2104
US

V. Phone/Fax

Practice location:
  • Phone: 213-217-5300
  • Fax: 213-217-5399
Mailing address:
  • Phone: 213-217-5300
  • Fax: 213-217-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN241278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: