Provider Demographics
NPI:1760835730
Name:CASTILLO, CARLOS
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 ESTATE LA GRANDE PRINCESSE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5166
Mailing Address - Country:US
Mailing Address - Phone:305-300-5856
Mailing Address - Fax:305-503-5405
Practice Address - Street 1:4040 ESTATE LA GRANDE PRINCESSE STE 3
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-5166
Practice Address - Country:US
Practice Address - Phone:305-300-5856
Practice Address - Fax:305-503-5405
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9350825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily