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General NPI Number Information
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NPI Number | 1922455104
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Entity Type | Organization
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Legal Business Name | CASTILLO'S MD SERVICES, LLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 1530 LEE BLVD SUITTE 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 | 239-369-2749
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Fax | 239-369-9158
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Provider Business Mailing Address
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Address Line | 13500 TROIA DR
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City | ESTERO
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State | FL
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Zip | 33928-7304
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Country | US
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Telephone | 239-369-2749
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Fax | 239-369-9158
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JESSIE CEPEDA
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Credential | RMA
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Telephone | 239-240-3005
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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 |
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License Number State |
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