Healthcare Provider Details

I. General information

NPI: 1346979903
Provider Name (Legal Business Name): PAOLA V CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 DANIELS PKWY
FORT MYERS FL
33912-1813
US

IV. Provider business mailing address

12520 WALDEN RUN DR
FORT MYERS FL
33913-8148
US

V. Phone/Fax

Practice location:
  • Phone: 239-364-5181
  • Fax:
Mailing address:
  • Phone: 239-994-7857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.027737
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN29547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: