1669555009 NPI number — MR. VICTOR M CASTILLO M.T.

Table of content: MR. VICTOR M CASTILLO M.T. (NPI 1669555009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669555009 NPI number — MR. VICTOR M CASTILLO M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
VICTOR
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669555009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANASCO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00610-1163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-826-2275
Provider Business Mailing Address Fax Number:
787-826-5211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
48 CALLE 65 INFANTERIA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANASCO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00610-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-826-2275
Provider Business Practice Location Address Fax Number:
787-826-5211
Provider Enumeration Date:
10/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246Z00000X , with the licence number:  359 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 359 . This is a "STATE LICENSURE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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