Provider Demographics
NPI:1154500569
Name:G. CASTELLVI, M.D.
Entity Type:Organization
Organization Name:G. CASTELLVI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:CASTELLVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-496-9900
Mailing Address - Street 1:PO BOX 320502
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2502
Mailing Address - Country:US
Mailing Address - Phone:813-496-9900
Mailing Address - Fax:813-496-9920
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:303
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-496-9900
Practice Address - Fax:813-496-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 44641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD20865Medicare UPIN
FL04050Medicare PIN