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General NPI Number Information
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NPI Number | 1679269260
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Entity Type | Individual
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Provider Name | ANDRES CASTILLA
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Gender | Male
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1100 S STATE ROAD 7 STE 201
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City | MARGATE
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State | FL
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Zip | 33068-4033
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Country | US
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Telephone | 954-440-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 11530 NW 56TH DR APT 109
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3139
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Country | US
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Telephone | 352-213-6235
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119382
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License Number State | FL
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