Healthcare Provider Details

I. General information

NPI: 1205005501
Provider Name (Legal Business Name): MARTA-INES CASTILLEJO BSN, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE FIRST FLOOR, TOWER I
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

1405 CLIFTON RD NE CHILDREN'S HEALTHCARE OF ATLANTA
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-4553
  • Fax:
Mailing address:
  • Phone: 404-785-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN099518
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: