Healthcare Provider Details

I. General information

NPI: 1528411774
Provider Name (Legal Business Name): FERNANDO ERNESTO CASADO CASTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 570
RENTON WA
98055-5700
US

IV. Provider business mailing address

2551 HOLIDAY RD APT E5
CORALVILLE IA
52241-2786
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3487
  • Fax: 425-690-9087
Mailing address:
  • Phone: 914-309-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61417522
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD-45957
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number74676
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD61417522
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: