Provider Demographics
NPI:1548406143
Name:CASTILLO, MARINA ORTIZ (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:ORTIZ
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 W LODI AVE STE P
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3038
Mailing Address - Country:US
Mailing Address - Phone:209-369-7493
Mailing Address - Fax:209-369-6858
Practice Address - Street 1:701 E CHANNEL ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2628
Practice Address - Country:US
Practice Address - Phone:209-944-4700
Practice Address - Fax:209-373-2873
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics