Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 191384 | MA |
Y | 363L00000X | Nurse Practitioner | 20391 | CA |
NPI | 1003940503 |
---|---|
Provider Name | Ligaya Castillo |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 20/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1902846306 | GROUP NPI (01) | CA |
GR0100430 | MEDICAL (01) | CA |
W18762 | GROUP MEDICARE (01) | CA |