Provider Demographics
NPI:1902600703
Name:CASTILLO ALBINO, KRISTI YANELY
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:YANELY
Last Name:CASTILLO ALBINO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 NE 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6663
Mailing Address - Country:US
Mailing Address - Phone:541-418-2008
Mailing Address - Fax:
Practice Address - Street 1:1613 NE 81ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6663
Practice Address - Country:US
Practice Address - Phone:541-418-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10035821363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics