Provider Demographics
NPI:1871307405
Name:CASTILLO, MARIA NANCY
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:NANCY
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 1:5555 E KINGS CANYON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4533
Mailing Address - Country:US
Mailing Address - Phone:559-255-1122
Mailing Address - Fax:
Practice Address - Street 1:5555 E KINGS CANYON RD STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4533
Practice Address - Country:US
Practice Address - Phone:559-255-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist