Healthcare Provider Details

I. General information

NPI: 1093291783
Provider Name (Legal Business Name): LILIAN CASTELLVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 EMPIRE CIR
LAS VEGAS NV
89107-1451
US

IV. Provider business mailing address

6100 EMPIRE CIR
LAS VEGAS NV
89107-1451
US

V. Phone/Fax

Practice location:
  • Phone: 702-624-8522
  • Fax:
Mailing address:
  • Phone: 702-624-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number856851
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: