Individual
LORENZO CASTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15552 W MOHAVE ST, GOODYEAR, AZ 85338-2930
(623) 236-3579
Mailing address
15552 W MOHAVE ST, GOODYEAR, AZ 85338-2930
(623) 236-3579
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
12312
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12312
LICENSE NUMBER
AZ
Enumeration date
04/19/2007
Last updated
10/10/2007
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