Provider Demographics
NPI:1144474206
Name:CASTOLO, JOSE ERNESTO (NP)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ERNESTO
Last Name:CASTOLO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 PHELPS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-9508
Mailing Address - Country:US
Mailing Address - Phone:559-935-4374
Mailing Address - Fax:559-935-4389
Practice Address - Street 1:1145 PHELPS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9508
Practice Address - Country:US
Practice Address - Phone:559-935-4374
Practice Address - Fax:559-935-4389
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481124164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse