Healthcare Provider Details

I. General information

NPI: 1437971108
Provider Name (Legal Business Name): FAVIOLA CASTILLO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E AVENIDA DE LA MERCED RM 103
MONTEBELLO CA
90640-2752
US

IV. Provider business mailing address

215 E AVENIDA DE LA MERCED RM 103
MONTEBELLO CA
90640-2752
US

V. Phone/Fax

Practice location:
  • Phone: 323-887-5324
  • Fax: 323-887-5801
Mailing address:
  • Phone: 323-887-5324
  • Fax: 323-887-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW109861
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: