1922145150 NPI number — MRS. ELISA MARIA CASTILLO M.A.

Table of content: MRS. ELISA MARIA CASTILLO M.A. (NPI 1922145150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922145150 NPI number — MRS. ELISA MARIA CASTILLO M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
ELISA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1922145150
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:
15 DULCINEA LN
Provider Second Line Business Mailing Address:
URB. PALMA REAL
Provider Business Mailing Address City Name:
RINCON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00677-9730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-594-3898
Provider Business Mailing Address Fax Number:
787-823-7954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 CALLE PABLO CASALS
Provider Second Line Business Practice Location Address:
SUITE1
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-3945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-594-3898
Provider Business Practice Location Address Fax Number:
787-823-7954
Provider Enumeration Date:
01/30/2007

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: 103T00000X , with the licence number:  1668 , 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)





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