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General NPI Number Information
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NPI Number | 1811440589
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Entity Type | Individual
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Provider Name | GLORIA LUZ CASTILLOVEITIA VEGA
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Gender | Female
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 10 CALLE CASIA 116A
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City | SAN JUAN
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State | PR
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Zip | 00717-3201
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Country | US
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Telephone | 787-709-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 4027 CALLE AURORA APT 521
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City | PONCE
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State | PR
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Zip | 00717-1598
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Country | US
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Telephone | 787-709-3533
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 316017
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 316017
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License Number State | NY
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