Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | ||
Y | 363LF0000X | Nurse Practitioner - Family Medicine | NP95004957 | CA |
NPI | 1093120099 |
---|---|
Provider Name | Melody Jean Castillo |
First Address | Merced, CA 95341-6805 |
Second Address | Merced, CA 95341-6805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 14/12/2016 |