MEDICARE: LEIVIS CASTILLO LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	323505	NY

General Provider Information

NPI Number	:	1043668114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIVIS CASTILLO LPN

Provider Business Mailing Address
First Line	:	29 MITCHELL PL
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-1804
Country	:	US
Telephone Number	:	914-396-3369
Fax Number	:	914-396-3369

Provider Business Practice Location Address
First Line	:	29 MITCHELL PL
Second Line	:
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-1804
Country	:	US
Telephone Number	:	914-396-3369
Fax Number	:	914-396-3369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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Directions to “ LEIVIS CASTILLO LPN” Practice Location

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