Provider Demographics
NPI:1861176463
Name:CASTILLON, MICHELLE MARIE (CNA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:CASTILLON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S H ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-1544
Mailing Address - Country:US
Mailing Address - Phone:760-457-9733
Mailing Address - Fax:
Practice Address - Street 1:317 S H ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-1544
Practice Address - Country:US
Practice Address - Phone:760-457-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01103582376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide