Healthcare Provider Details

I. General information

NPI: 1124499512
Provider Name (Legal Business Name): SOFIA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10547 GREENWOOD AVE N
SEATTLE WA
98133-8720
US

IV. Provider business mailing address

1713 4TH ST NE
AUBURN WA
98002-5125
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-4100
  • Fax:
Mailing address:
  • Phone: 206-898-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA 60514566
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: