Provider Demographics
NPI:1255868618
Name:CASTILLO SERULLE, ISRAEL ELIAS
Entity Type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:ELIAS
Last Name:CASTILLO SERULLE
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 1:9470 LIVE OAK PL APT 109
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4772
Mailing Address - Country:US
Mailing Address - Phone:954-995-6062
Mailing Address - Fax:
Practice Address - Street 1:9470 LIVE OAK PL APT 109
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4772
Practice Address - Country:US
Practice Address - Phone:954-995-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-318246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant