Provider Demographics
NPI:1699433821
Name:CASTILLO, ERICKA ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:ELIZABETH
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9575 WELDON CIR APT C310
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-0972
Mailing Address - Country:US
Mailing Address - Phone:954-243-7498
Mailing Address - Fax:
Practice Address - Street 1:9575 WELDON CIR APT C310
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-0972
Practice Address - Country:US
Practice Address - Phone:954-243-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered