Healthcare Provider Details

I. General information

NPI: 1609707728
Provider Name (Legal Business Name): MARLON ANGQUICO CASTILLO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14541 DELANO ST
VAN NUYS CA
91411-2820
US

IV. Provider business mailing address

14541 DELANO ST
VAN NUYS CA
91411-2820
US

V. Phone/Fax

Practice location:
  • Phone: 310-292-6065
  • Fax:
Mailing address:
  • Phone: 310-292-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number757574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: