1609908250 NPI number — MS. DIANA XIMENA CASTILLO-EDDY MS.

Table of content: MS. DIANA XIMENA CASTILLO-EDDY MS. (NPI 1609908250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609908250 NPI number — MS. DIANA XIMENA CASTILLO-EDDY MS.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO-EDDY
Provider First Name:
DIANA
Provider Middle Name:
XIMENA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTILLO
Provider Other First Name:
DIANA
Provider Other Middle Name:
XIMENA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609908250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1854
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCADIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-375-7224
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-4262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-375-7224
Provider Business Practice Location Address Fax Number:
818-484-8177
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 46085 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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