Provider Demographics
NPI:1053876458
Name:PINKY CASTILLO & GLENN CASTILLO, DBA
Entity type:Organization
Organization Name:PINKY CASTILLO & GLENN CASTILLO, DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:PINKY
Authorized Official - Middle Name:ROXAS
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:720-220-4599
Mailing Address - Street 1:7295 S VIA BOCA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-8360
Mailing Address - Country:US
Mailing Address - Phone:720-220-4599
Mailing Address - Fax:
Practice Address - Street 1:7295 S VIA BOCA DEL MAR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-8360
Practice Address - Country:US
Practice Address - Phone:720-220-4599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care