Provider Demographics
NPI:1861933756
Name:CASTILLO, REGINALD (ATC, EMT-P)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:ATC, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 EAST CIRCLE DR. #206
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60445
Mailing Address - Country:US
Mailing Address - Phone:708-348-8954
Mailing Address - Fax:
Practice Address - Street 1:4939 EAST CIRCLE DR. #206
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445
Practice Address - Country:US
Practice Address - Phone:708-388-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic