Healthcare Provider Details

I. General information

NPI: 1689202319
Provider Name (Legal Business Name): ANNA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 PARK CENTER DR
SANTEE CA
92071-6957
US

IV. Provider business mailing address

655 PARK CENTER DR
SANTEE CA
92071-6957
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-5500
  • Fax: 619-596-5501
Mailing address:
  • Phone: 619-596-5500
  • Fax: 619-596-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number751770
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: