Provider Demographics
NPI:1285111492
Name:CASTILLO-LOEZA, STEPHANIE LIZBETH
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LIZBETH
Last Name:CASTILLO-LOEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N LAMB BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4603
Mailing Address - Country:US
Mailing Address - Phone:702-513-9594
Mailing Address - Fax:
Practice Address - Street 1:526 S TONOPAH DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4043
Practice Address - Country:US
Practice Address - Phone:702-601-7452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool