Healthcare Provider Details

I. General information

NPI: 1033981436
Provider Name (Legal Business Name): MENCHU CASTILLO IGNACIO AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E BELMONT CT
PLACENTIA CA
92870-7400
US

IV. Provider business mailing address

1855 E BELMONT CT
PLACENTIA CA
92870-7400
US

V. Phone/Fax

Practice location:
  • Phone: 626-221-3477
  • Fax:
Mailing address:
  • Phone: 626-221-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95021807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: