=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154500569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G. CASTELLVI, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2007
-----------------------------------------------------
Last Update Date | 11/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6101 WEBB RD 303
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33615-2872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-496-9900
-----------------------------------------------------
Fax | 813-496-9920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 320502
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33679-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-496-9900
-----------------------------------------------------
Fax | 813-496-9920
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. WILLIE O CASTELLVI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 813-496-9900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME 44641
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------