Healthcare Provider Details

I. General information

NPI: 1235399874
Provider Name (Legal Business Name): MRS. MARIA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 STEFANO DR
STOCKTON CA
95212-3550
US

IV. Provider business mailing address

3151 STEFANO DR
STOCKTON CA
95212-3550
US

V. Phone/Fax

Practice location:
  • Phone: 209-547-1215
  • Fax: 209-464-4765
Mailing address:
  • Phone: 209-547-1215
  • Fax: 209-464-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: