Provider Demographics
NPI:1437590536
Name:CORNERSTONE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY MEDICINE LLC
Other - Org Name:CORNERSTONE FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANABEL
Authorized Official - Middle Name:CARLOTO
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-900-3472
Mailing Address - Street 1:9310 OLD KINGS RD S STE 1303
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8100
Mailing Address - Country:US
Mailing Address - Phone:904-900-3472
Mailing Address - Fax:904-503-2373
Practice Address - Street 1:9310 OLD KINGS RD SOUTH
Practice Address - Street 2:UNIT 1303
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-3225
Practice Address - Country:US
Practice Address - Phone:904-900-3472
Practice Address - Fax:904-503-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty