MEDICARE: ANDRES CASTILLA

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		FL
2	363A00000X	Physician Assistant	PA9119382	FL

General Provider Information

NPI Number	:	1679269260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES CASTILLA

Provider Business Mailing Address
First Line	:	11530 NW 56TH DR APT 109
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3139
Country	:	US
Telephone Number	:	352-213-6235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S STATE ROAD 7 STE 201
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33068-4033
Country	:	US
Telephone Number	:	954-440-5570
Fax Number	:

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

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	11/12/2024

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Directions to “ ANDRES CASTILLA ” Practice Location

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