Provider Demographics
NPI:1316292295
Name:CASTILLO, DEBORAH (LPN)
Entity type:Individual
Prefix:
First Name:DEBORAH
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 1:3333 82ND ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1421
Mailing Address - Country:US
Mailing Address - Phone:347-730-3213
Mailing Address - Fax:
Practice Address - Street 1:3333 82ND ST
Practice Address - Street 2:APT 3B
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1446
Practice Address - Country:US
Practice Address - Phone:347-730-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303436164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY303436OtherLICENSED PRACTICAL NURSE