Healthcare Provider Details

I. General information

NPI: 1144151333
Provider Name (Legal Business Name): DIEGO A CASTELLOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 PERRY CREEK RD
RALEIGH NC
27616-5704
US

IV. Provider business mailing address

3296 ZELSNACK RD
MARATHON NY
13803-2240
US

V. Phone/Fax

Practice location:
  • Phone: 585-645-7110
  • Fax:
Mailing address:
  • Phone: 585-645-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: