Healthcare Provider Details

I. General information

NPI: 1225730195
Provider Name (Legal Business Name): AMADOR CASTILLO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 SCENIC DR
ALAMOGORDO NM
88310-8700
US

IV. Provider business mailing address

2669 SCENIC DR
ALAMOGORDO NM
88310-8700
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4036015
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14997
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71708
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: