Provider Demographics
NPI:1073526513
Name:CASTILLO, TORIBIO
Entity Type:Individual
Prefix:
First Name:TORIBIO
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:
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 24001
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-4001
Mailing Address - Country:US
Mailing Address - Phone:954-267-8777
Mailing Address - Fax:954-772-7801
Practice Address - Street 1:6550 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:STE 512
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1417
Practice Address - Country:US
Practice Address - Phone:954-267-8777
Practice Address - Fax:954-772-7801
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100716363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291223600Medicaid
FLP55302Medicare UPIN
FL291223600Medicaid
FLE7196VMedicare ID - Type Unspecified