MEDICARE: MISS DESIREE CASTILLO L.P.N.

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	2848101	NY

General Provider Information

NPI Number	:	1215073846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DESIREE CASTILLO L.P.N.

Provider Business Mailing Address
First Line	:	PO BOX 963
Second Line	:
City	:	SOUND BEACH
State	:	NY
Zip	:	11789-2632
Country	:	US
Telephone Number	:	631-339-1998
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 BEECHWOOD CT
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2234
Country	:	US
Telephone Number	:	631-339-1998
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	05/05/2015

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