Healthcare Provider Details

I. General information

NPI: 1629594858
Provider Name (Legal Business Name): CASTILLO PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89102-1964
US

IV. Provider business mailing address

10548 ALLTHORN AVE
LAS VEGAS NV
89144-4488
US

V. Phone/Fax

Practice location:
  • Phone: 702-790-2701
  • Fax:
Mailing address:
  • Phone: 626-664-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON MICHAEL CASTILLO
Title or Position: MANAGER
Credential: DO
Phone: 626-664-6965