Basic Information
| Provider Information | |||||||||
| NPI: | 1275090912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | DENISSE | ||||||||
| MiddleName: | ALEJANDRA | ||||||||
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| Credential: | CPNP-PC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANGULO | ||||||||
| OtherFirstName: | DENISSE | ||||||||
| OtherMiddleName: | ALEJANDRA | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7904 GREENEBROOK CT | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX STA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220393170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032207882 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 163 FORT EVANS RD NE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034432000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2019 | ||||||||
| LastUpdateDate: | 03/01/2019 | ||||||||
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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 | 208000000X | 0024177348 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0001236163 | 01 | VA | BOARD OF NURSING DEPARTMENT OF HEALTH PROFESSIONALS | OTHER | 0024177348 | 01 | VA | BOARD OF NURSING DEPARTMENT OF HEALTH PREFESSIONALS | OTHER | 201912307 | 01 | PEDIATRIC NURSING CERTIFICATION BOARD | OTHER |