Healthcare Provider Details

I. General information

NPI: 1265977995
Provider Name (Legal Business Name): JOSE M DEL CASTILLO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 05/23/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SHADOW LN STE 400
LAS VEGAS NV
89106-4159
US

IV. Provider business mailing address

70 E MULBERRY LN
LEEDS UT
84746-7768
US

V. Phone/Fax

Practice location:
  • Phone: 435-256-5904
  • Fax:
Mailing address:
  • Phone: 435-256-5904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSL2166
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: