Provider Demographics
NPI:1033696802
Name:CASTILLO MIESES, CRISTINA P (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:P
Last Name:CASTILLO MIESES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7601
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-7601
Mailing Address - Country:US
Mailing Address - Phone:787-467-3053
Mailing Address - Fax:
Practice Address - Street 1:B2 CALLE SOLEDAD EXT ESTANCIAS DEL SOL
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-467-3053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021034208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice