1154733632 NPI number — CASTILLO & TORRES MD PA

Table of content: (NPI 1154733632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154733632 NPI number — CASTILLO & TORRES MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTILLO & TORRES MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154733632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2328 S CONGRESS AVE
Provider Second Line Business Mailing Address:
SUITE 1E
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33406-7618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-324-7224
Provider Business Mailing Address Fax Number:
561-246-4859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2328 S CONGRESS AVE
Provider Second Line Business Practice Location Address:
SUITE 1E
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33406-7618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-324-7224
Provider Business Practice Location Address Fax Number:
561-246-4859
Provider Enumeration Date:
06/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
561-324-7224

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME108476 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 012072900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105328700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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