MEDICARE: CARINA 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	320576	NY

General Provider Information

NPI Number	:	1780080507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARINA CASTILLO LPN

Provider Business Mailing Address
First Line	:	1065 JEROME AVE
Second Line	:	APT. 3E
City	:	BRONX
State	:	NY
Zip	:	10452-4809
Country	:	US
Telephone Number	:	347-290-3170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 JEROME AVENUE
Second Line	:	APT 3E
City	:	BRONX
State	:	NY
Zip	:	10452-4807
Country	:	US
Telephone Number	:	347-290-3170
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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