Healthcare Provider Details

I. General information

NPI: 1225872807
Provider Name (Legal Business Name): ANGELA B CASTILLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD # 110
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

98-1375 HOOHIKI ST
PEARL CITY HI
96782-2303
US

V. Phone/Fax

Practice location:
  • Phone: 808-538-2503
  • Fax:
Mailing address:
  • Phone: 808-428-0584
  • Fax: 808-744-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number58576
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: