Provider Demographics
NPI:1699599068
Name:CASTILLO, NOE DANIEL
Entity type:Individual
Prefix:
First Name:NOE
Middle Name:DANIEL
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1058 KEKUILANI LOOP APT 205
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2725
Mailing Address - Country:US
Mailing Address - Phone:239-898-6622
Mailing Address - Fax:
Practice Address - Street 1:91-1058 KEKUILANI LOOP APT 205
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2725
Practice Address - Country:US
Practice Address - Phone:239-898-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty