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General NPI Number Information
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NPI Number | 1508039819
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Entity Type | Individual
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Provider Name | EDGARDO CASTILLO-NIEVES MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 1530 LEE BLVD SUITE 1600
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-4893
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Country | US
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Telephone | 239-368-7310
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Fax | 239-368-7312
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Provider Business Mailing Address
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Address Line | 1530 LEE BLVD STE 1400
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-4887
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Country | US
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Telephone | 239-368-7310
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Fax | 239-368-7312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 26,410-R
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License Number State | PR
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