Healthcare Provider Details

I. General information

NPI: 1568326254
Provider Name (Legal Business Name): CARMEN CECILIA CASTILLO REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 FANSHAWE ST
PHILADELPHIA PA
19111-4923
US

IV. Provider business mailing address

1213 FANSHAWE ST
PHILADELPHIA PA
19111-4923
US

V. Phone/Fax

Practice location:
  • Phone: 215-960-4887
  • Fax: 215-960-4887
Mailing address:
  • Phone: 215-960-4887
  • Fax: 215-960-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: