Healthcare Provider Details

I. General information

NPI: 1376026070
Provider Name (Legal Business Name): VIVIAN MONET CASTILLO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 CORONA DR STE 260
CORPUS CHRISTI TX
78411-4395
US

IV. Provider business mailing address

1090 LANG RD APT 2503
PORTLAND TX
78374-3113
US

V. Phone/Fax

Practice location:
  • Phone: 361-334-1609
  • Fax: 361-906-0478
Mailing address:
  • Phone: 361-960-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number175118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: