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NPI Code Detail

MEDICARE: MRS. JILLIAN ROSE CASTILLO NP

MEDICARE: MRS. JILLIAN ROSE CASTILLO NP
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
1363LG0600XGerontology Nurse Practitioner831935NV

General Provider Information

NPI Number : 1184241226
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILLIAN ROSE CASTILLO NP
Provider Business Mailing Address
First Line : PO BOX 7362
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96158-0362
Country : US
Telephone Number : 530-318-8653
Fax Number :
Provider Business Practice Location Address
First Line : 1005 TERMINAL WAY STE 184
Second Line :
City : RENO
State : NV
Zip : 89502-2179
Country : US
Telephone Number : 214-868-4371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2020
Last Update Date : 07/05/2020

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