Basic Information
| Provider Information | |||||||||
| NPI: | 1588280002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | RANIER VINCE | ||||||||
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| Credential: | MS, RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 W CASTELLANO DR UNIT 124 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799126189 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 N OREGON ST | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155776011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2020 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 86152061 | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.