Basic Information
| Provider Information | |||||||||
| NPI: | 1205034725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | TERESITA | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14242 ROSCOE BLVD APT 102 | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003263254 | ||||||||
| FaxNumber: | 7145713560 | ||||||||
| Practice Location | |||||||||
| Address1: | 44407 CHALLENGER WAY | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935353237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613413100 | ||||||||
| FaxNumber: | 6619422305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 50448 | CA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | D50448 | 05 | CA | MEDICAID |