Provider Demographics
NPI:1912293374
Name:CASTILLO PRIMARY CARE
Entity type:Organization
Organization Name:CASTILLO PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:719-225-6510
Mailing Address - Street 1:1401 ANITA ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2122
Mailing Address - Country:US
Mailing Address - Phone:719-225-6510
Mailing Address - Fax:719-542-3514
Practice Address - Street 1:1401 ANITA ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2122
Practice Address - Country:US
Practice Address - Phone:719-225-6510
Practice Address - Fax:719-542-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4815261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care