Provider Demographics
NPI:1760200083
Name:CASTILLO, BOLOR TSETSEG
Entity type:Individual
Prefix:
First Name:BOLOR
Middle Name:TSETSEG
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 CORAL LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-6802
Mailing Address - Country:US
Mailing Address - Phone:312-888-5424
Mailing Address - Fax:
Practice Address - Street 1:3173 CORAL LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-6802
Practice Address - Country:US
Practice Address - Phone:312-888-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist