Healthcare Provider Details

I. General information

NPI: 1558364448
Provider Name (Legal Business Name): JORGE I CASTELLVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 W SWANN AVE 2ND FLOOR
TAMPA FL
33606-2404
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-254-7079
  • Fax: 813-443-8164
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME51403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: