Individual
MRS. MARIA CASTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3151 STEFANO DR, STOCKTON, CA 95212-3550
(209) 547-1215
(209) 464-4765
Mailing address
3151 STEFANO DR, STOCKTON, CA 95212-3550
(209) 547-1215
(209) 464-4765
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN01069F
MEDI-CAL PROVIDER
CA
Enumeration date
06/16/2008
Last updated
06/16/2008
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