Provider Demographics
NPI:1053313858
Name:CASTILLO-POWELL, MARIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:CASTILLO-POWELL
Suffix:
Gender:F
Credentials:PA-C
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 843298
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3298
Mailing Address - Country:US
Mailing Address - Phone:910-215-5100
Mailing Address - Fax:910-215-5114
Practice Address - Street 1:7473-C HWY 22
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-8514
Practice Address - Country:US
Practice Address - Phone:910-215-5100
Practice Address - Fax:910-215-5114
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ816530Medicaid
Q07638Medicare UPIN
AZZ77923Medicare PIN