1760689400 NPI number — DR. MARTA ANISIA CASTILLO M.D.

Table of content: DR. MARTA ANISIA CASTILLO M.D. (NPI 1760689400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760689400 NPI number — DR. MARTA ANISIA CASTILLO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
MARTA
Provider Middle Name:
ANISIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1760689400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5403 NW 20TH CT APT C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32653-2179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-282-0147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7765 S COUNTY ROAD 231
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE BUTLER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-496-6121
Provider Business Practice Location Address Fax Number:
386-496-6083
Provider Enumeration Date:
06/27/2007

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: 208D00000X , with the licence number:  ACN219 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16,111 . This is a "P.RICO LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ACN 219 . This is a "AREACRITICAL NEED LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".