Healthcare Provider Details

I. General information

NPI: 1811440589
Provider Name (Legal Business Name): GLORIA LUZ CASTILLOVEITIA VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA 116A
SAN JUAN PR
00717-3201
US

IV. Provider business mailing address

4027 CALLE AURORA APT 521
PONCE PR
00717-1598
US

V. Phone/Fax

Practice location:
  • Phone: 787-709-3533
  • Fax:
Mailing address:
  • Phone: 787-709-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number316017
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number316017
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: