Provider Demographics
NPI:1538218474
Name:CASTILLO, DAMIAN H (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:H
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 HARDWARE DR NE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2017
Mailing Address - Country:US
Mailing Address - Phone:505-341-1300
Mailing Address - Fax:505-341-0956
Practice Address - Street 1:4811 HARDWARE DR NE
Practice Address - Street 2:SUITE C-2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2017
Practice Address - Country:US
Practice Address - Phone:505-341-1300
Practice Address - Fax:505-341-0956
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM645237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist