=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760595524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZENAIDA CASTILLO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAMELIA ST #1327 URB. ROLLING HILL
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-0344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-642-7357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PMB #17 PO BOX 70344
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936-0344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-642-7357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 15746
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------