Provider Demographics
NPI:1043200470
Name:CASTILLO, LAZARO LUIS (MD)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:LUIS
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 CHIQUITA BLVD S STE 110
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4267
Mailing Address - Country:US
Mailing Address - Phone:239-677-6399
Mailing Address - Fax:239-542-7881
Practice Address - Street 1:3208 CHIQUITA BLVD S STE 110
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4267
Practice Address - Country:US
Practice Address - Phone:239-549-1398
Practice Address - Fax:239-542-7881
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74018207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F23902Medicare UPIN
FL42460ZMedicare PIN