Healthcare Provider Details

I. General information

NPI: 1558020149
Provider Name (Legal Business Name): DR. KATIANA NICOLE CASTILLO-CAMARENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 01/15/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MONTALVA #23
ENSENADA PR
00647
US

IV. Provider business mailing address

PO BOX 994
BOQUERON PR
00622-0994
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-3377
  • Fax:
Mailing address:
  • Phone: 787-951-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6964
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: