Healthcare Provider Details

I. General information

NPI: 1881658144
Provider Name (Legal Business Name): MAURICIO JOSE CASTELLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 S HARBOR CITY BLVD STE 301
MELBOURNE FL
32901
US

IV. Provider business mailing address

1499 S HARBOR CITY BLVD STE 301
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-729-9909
  • Fax: 321-728-0288
Mailing address:
  • Phone: 321-729-9909
  • Fax: 321-728-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME81968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: