Provider Demographics
NPI:1699429704
Name:CASTILLO, CYNTHIA (FNP-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19069 VAN BUREN BLVD STE 114-174
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9169
Mailing Address - Country:US
Mailing Address - Phone:951-290-4000
Mailing Address - Fax:909-265-9423
Practice Address - Street 1:6780 INDIANA AVE STE 170
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4284
Practice Address - Country:US
Practice Address - Phone:951-680-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022514363LF0000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty