MEDICARE: TISHA CASTILLO MHP. NBC-HWC

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1437875382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TISHA CASTILLO MHP. NBC-HWC

Provider Business Mailing Address
First Line	:	530 E HUNT HWY STE 103-262
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-5229
Country	:	US
Telephone Number	:	480-269-2708
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 E HUNT HWY STE 103-262
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-5229
Country	:	US
Telephone Number	:	480-269-2708
Fax Number	:

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

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	10/12/2022

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