Individual
CARLY CASTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1080 GROVE ST, SAN LUIS OBISPO, CA 93401-2912
(805) 248-9513
Mailing address
PO BOX 15807, SAN LUIS OBISPO, CA 93406-5807
(805) 248-9513
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
86120000
—
Other
Enumeration date
11/15/2020
Last updated
11/15/2020
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