MEDICARE: LIZBETH CASTILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1114631744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZBETH CASTILLO

Provider Business Mailing Address
First Line	:	82160 BLISS AVE
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-4104
Country	:	US
Telephone Number	:	760-609-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	473 E. CARNEGIE DRIVE
Second Line	:
City	:	SAN BERNANDINO
State	:	CA
Zip	:	92408
Country	:	US
Telephone Number	:	760-609-8044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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Directions to “ LIZBETH CASTILLO ” Practice Location

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