Provider Demographics
NPI:1396826574
Name:DELCASTILLO, TEOFILO A (MD)
Entity Type:Individual
Prefix:DR
First Name:TEOFILO
Middle Name:A
Last Name:DELCASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:250 N KEPLER RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4712
Mailing Address - Country:US
Mailing Address - Phone:386-822-9943
Mailing Address - Fax:386-626-2380
Practice Address - Street 1:250 N KEPLER RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4712
Practice Address - Country:US
Practice Address - Phone:386-295-5438
Practice Address - Fax:386-736-1321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00260592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18101Medicare PIN