Healthcare Provider Details

I. General information

NPI: 1689436008
Provider Name (Legal Business Name): YELITZA ALEJANDRA CASTILLO ASTORGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PARK AVE
SAINT LOUIS MO
63104-3024
US

IV. Provider business mailing address

839 HOLLOWBROOK DR
BRENTWOOD CA
94513-6122
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-2700
  • Fax:
Mailing address:
  • Phone: 636-241-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: