Provider Demographics
NPI:1124615950
Name:CASTILLO, IRENE (RDN)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S G ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-6039
Mailing Address - Country:US
Mailing Address - Phone:949-769-0343
Mailing Address - Fax:
Practice Address - Street 1:1500 CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3725
Practice Address - Country:US
Practice Address - Phone:805-738-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered