Provider Demographics
NPI:1538868575
Name:CASTRO, NIKKO DE LEON
Entity type:Individual
Prefix:
First Name:NIKKO
Middle Name:DE LEON
Last Name:CASTRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11733 SE 249TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6644
Mailing Address - Country:US
Mailing Address - Phone:907-519-8136
Mailing Address - Fax:
Practice Address - Street 1:11733 SE 249TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6644
Practice Address - Country:US
Practice Address - Phone:907-519-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant