Provider Demographics
NPI:1962156430
Name:CASTILLO, JOHN DAVID (CCSS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 VIA ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-2611
Mailing Address - Country:US
Mailing Address - Phone:575-650-7471
Mailing Address - Fax:
Practice Address - Street 1:920 N ALAMEDA BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2291
Practice Address - Country:US
Practice Address - Phone:575-993-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator