Healthcare Provider Details

I. General information

NPI: 1023956026
Provider Name (Legal Business Name): CHRISTOPHER CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 PROSPECT PL NE
ALBUQUERQUE NM
87110-4311
US

IV. Provider business mailing address

8521 TRUMBULL AVE SE APT C
ALBUQUERQUE NM
87108-4492
US

V. Phone/Fax

Practice location:
  • Phone: 505-390-2080
  • Fax:
Mailing address:
  • Phone: 505-539-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: