Healthcare Provider Details

I. General information

NPI: 1427178722
Provider Name (Legal Business Name): PAULINE SOPHIE CASTILLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ANITA ST
PUEBLO CO
81001-2122
US

IV. Provider business mailing address

1401 ANITA ST.
PUEBLO CO
81001-2122
US

V. Phone/Fax

Practice location:
  • Phone: 719-225-6510
  • Fax: 719-542-3514
Mailing address:
  • Phone: 719-225-6510
  • Fax: 719-542-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4815
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number164080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: