Provider Demographics
NPI:1386126654
Name:CASTILLO, VICTORIA LYNN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:CASTILLO
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 1:3558 44TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-3414
Mailing Address - Country:US
Mailing Address - Phone:619-840-9953
Mailing Address - Fax:
Practice Address - Street 1:4275 EL CAJON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1293
Practice Address - Country:US
Practice Address - Phone:619-283-9624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health