Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | A159673 | CA |
NPI | 1902330723 |
---|---|
Provider Name | Stephanie Castillo |
First Address | San Ysidro, CA 92173-1345 |
Second Address | San Ysidro, CA 92173-1345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 03/08/2021 |