Healthcare Provider Details

I. General information

NPI: 1518120930
Provider Name (Legal Business Name): JOSE V CASTELLANOS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 13TH ST SUITE 203
BOCA RATON FL
33486-2335
US

IV. Provider business mailing address

PO BOX 810533
BOCA RATON FL
33481-0533
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-5993
  • Fax: 561-391-5946
Mailing address:
  • Phone: 561-391-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE V CASTELLANOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-391-5993