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General NPI Number Information
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NPI Number | 1992527121
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Entity Type | Individual
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Provider Name | ISMAEL CASTILLO SR. PHD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1452 AVE ASHFORD STE 409
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City | SAN JUAN
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State | PR
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Zip | 00907-1563
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Country | US
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Telephone | 787-233-1663
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Fax |
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Provider Business Mailing Address
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Address Line | 23A #A33 COLINAS DE MONTE CARLO
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-310-3020
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 006337
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License Number State | PR
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