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Carly Castillo

NPI Registration Record

Provider / OrganizationNPIDate Certified
CARLY CASTILLO15387614402020-11-15
Entity TypeIndividual
Provider Name Carly Castillo
Practice Office Address1080 GROVE ST
SAN LUIS OBISPO, CA US
Practice Office Telephone8052489513
Mailing AddressPO BOX 15807
SAN LUIS OBISPO, CA 934065807 US
Business Telephone8052489513
HPT Codes
CodeLicense NoState
136A00000X PRIMARY86120000
OPI Codes

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