Healthcare Provider Details

I. General information

NPI: 1083060974
Provider Name (Legal Business Name): BRENDA ILIANA CASTILLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 SW 25TH ST STE B
OKLAHOMA CITY OK
73109-5927
US

IV. Provider business mailing address

PO BOX 891625
OKLAHOMA CITY OK
73189-1625
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax:
Mailing address:
  • Phone: 915-253-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number222989
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP130736
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: