Basic Information
| Provider Information | |||||||||
| NPI: | 1326501743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTILLO VALLADARES | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | BERNABE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 DIVISADERO ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941153011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153537800 | ||||||||
| FaxNumber: | 4153537800 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 ROBBINS ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035737284 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2019 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.