Provider Demographics
NPI:1053977264
Name:GAUDARD-CASTILLO, HELENE (MASTER)
Entity type:Individual
Prefix:MRS
First Name:HELENE
Middle Name:
Last Name:GAUDARD-CASTILLO
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9561 E PROSPECT LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9426
Mailing Address - Country:US
Mailing Address - Phone:520-241-1277
Mailing Address - Fax:
Practice Address - Street 1:3333 N CAMPBELL AVE STE 12
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2362
Practice Address - Country:US
Practice Address - Phone:520-241-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty