Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 32615 | TX |
NPI | 1134428766 |
---|---|
Provider Name | Dr. Ivette Laura Castillo |
First Address | Bellaire, TX 77401-3500 |
Second Address | Sugar Land, TX 77478-3177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 28/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288984201 | (05) | TX |