Provider Demographics
NPI:1083928568
Name:CASTILLO, MARIO CLARO RAMONES (MSN-CRNA)
Entity Type:Individual
Prefix:
First Name:MARIO CLARO
Middle Name:RAMONES
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MSN-CRNA
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:STE 8490
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-955-6161
Mailing Address - Fax:215-923-5507
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:STE 8490
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6161
Practice Address - Fax:215-923-5507
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2016-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PARN326635L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA208071Medicare PIN