1760487839 NPI number — JULIANNA M CASTRO APN

Table of content: JULIANNA M CASTRO APN (NPI 1760487839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760487839 NPI number — JULIANNA M CASTRO APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTRO
Provider First Name:
JULIANNA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

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:
1760487839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 44TH AVENUE DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-8126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-779-5670
Provider Business Mailing Address Fax Number:
309-779-5675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 44TH AVENUE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-8126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-779-5670
Provider Business Practice Location Address Fax Number:
309-779-5675
Provider Enumeration Date:
06/16/2005

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: 363LF0000X , with the licence number:  209-000723 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: A-083274 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 97792 . This is a "WELLMARK BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64903 . This is a "IOWA HEALTH SOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4796890024 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: IL0113 . This is a "JOHN DEERE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01371975 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 048919 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".




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