Castillo Primary Care | |
1401 Anita St Pueblo CO 81001-2122 | |
(719) 225-6510 | |
(719) 542-3514 |
Full Name | Castillo Primary Care |
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Speciality | Clinic/Center |
Location | 1401 Anita St, Pueblo, Colorado |
Authorized Official Name and Position | Pauline S. Castillo (OWNER/PROVIDER) |
Authorized Official Contact | 7192256510 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Castillo Primary Care 1401 Anita St Pueblo CO 81001-2122 Ph: (719) 225-6510 | Castillo Primary Care 1401 Anita St Pueblo CO 81001-2122 Ph: (719) 225-6510 |
NPI Number | 1912293374 |
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Provider Enumeration Date | 06/23/2011 |
Last Update Date | 06/23/2011 |
Medicare PECOS PAC ID | 0547558876 |
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Medicare Enrollment ID | O20161019001042 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912293374 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 4815 (Colorado) | Primary |
Provider Name | Valarie A Mills |
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Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
Provider Identifiers | NPI Number: 1144297185 PECOS PAC ID: 1951209337 Enrollment ID: I20200914002272 |
Provider Name | Patricia Donegan |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679267090 PECOS PAC ID: 4486015120 Enrollment ID: I20230727004132 |
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