Healthcare Provider Details

I. General information

NPI: 1649522046
Provider Name (Legal Business Name): ALICIA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1210
US

IV. Provider business mailing address

8310 ROBIN AVE NE
ALBUQUERQUE NM
87110-6030
US

V. Phone/Fax

Practice location:
  • Phone: 505-369-1275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: