Healthcare Provider Details

I. General information

NPI: 1558881581
Provider Name (Legal Business Name): ISABEL CRISTINA CASTILLO HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500-10 APT 201B
PHILADELPHIA PA
19124
US

IV. Provider business mailing address

1100 S BROAD ST UNIT 201B
PHILADELPHIA PA
19146-5026
US

V. Phone/Fax

Practice location:
  • Phone: 215-510-0029
  • Fax:
Mailing address:
  • Phone: 215-510-0029
  • Fax: 215-456-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT213865
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD470783
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: