MEDICARE: JORGE ENRIQUE CASTILLO MOLINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	15137-I	PR
2	208D00000X	General Practice Physician	ACN1281	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306474010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ENRIQUE CASTILLO MOLINA

Provider Business Mailing Address
First Line	:	7555 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1511
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

Provider Business Practice Location Address
First Line	:	7555 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1511
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2020
Last Update Date	:	03/05/2024

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