=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386210433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASTILLO Y ASOCIADOS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2021
-----------------------------------------------------
Last Update Date | 05/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 AVE MUNOZ RIVERA APT 1001
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-957-5788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1007 AVE MUNOZ RIVERA APT 1001
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-957-5788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JUANA P CASTILLO MUNOZ
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 787-957-5788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------