Healthcare Provider Details

I. General information

NPI: 1811144884
Provider Name (Legal Business Name): MICHAEL J. CASTILLO CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 EL PASEO RD
LAS CRUCES NM
88001-6013
US

IV. Provider business mailing address

PO BOX 1560
LAS CRUCES NM
88004-1560
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-2600
  • Fax: 575-527-5342
Mailing address:
  • Phone: 575-647-8366
  • Fax: 575-647-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR48333
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: