Healthcare Provider Details

I. General information

NPI: 1801658042
Provider Name (Legal Business Name): JOSE CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

IV. Provider business mailing address

9209 HONDO VALLEY PL SW
ALBUQUERQUE NM
87121-8697
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-2551
  • Fax: 505-243-0446
Mailing address:
  • Phone: 505-243-2551
  • Fax: 505-243-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: