Provider Demographics
NPI:1215073846
Name:CASTILLO, DESIREE (LPN)
Entity type:Individual
Prefix:MISS
First Name:DESIREE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2632
Mailing Address - Country:US
Mailing Address - Phone:631-339-1998
Mailing Address - Fax:
Practice Address - Street 1:2 BEECHWOOD CT
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2234
Practice Address - Country:US
Practice Address - Phone:631-339-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2848101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse