Provider Demographics
NPI:1720810237
Name:CASTILLO, DOMINIC GILBERT (PMHNP-BC, DNP, RN)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:GILBERT
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PMHNP-BC, DNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10459 MOUNTAIN VIEW AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2033
Mailing Address - Country:US
Mailing Address - Phone:909-792-6262
Mailing Address - Fax:
Practice Address - Street 1:1007 E COOLEY DR STE 109
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3901
Practice Address - Country:US
Practice Address - Phone:909-370-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner