Healthcare Provider Details

I. General information

NPI: 1538218474
Provider Name (Legal Business Name): DAMIAN H CASTILLO BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 HARDWARE DR NE SUITE C-2
ALBUQUERQUE NM
87109-2017
US

IV. Provider business mailing address

4811 HARDWARE DR NE SUITE C-2
ALBUQUERQUE NM
87109-2017
US

V. Phone/Fax

Practice location:
  • Phone: 505-341-1300
  • Fax: 505-341-0956
Mailing address:
  • Phone: 505-341-1300
  • Fax: 505-341-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number645
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: