Provider Demographics
NPI:1366460149
Name:CASTILLO, FAUSTO P (MD)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:P
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15475 SW 13TH TER
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2597
Mailing Address - Country:US
Mailing Address - Phone:786-499-6521
Mailing Address - Fax:786-518-2407
Practice Address - Street 1:15475 SW 13TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2597
Practice Address - Country:US
Practice Address - Phone:786-499-6521
Practice Address - Fax:786-518-2407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17657208D00000X
FLME17657208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93870Medicare ID - Type Unspecified