Provider Demographics
NPI:1558364448
Name:CASTELLVI, JORGE I (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:I
Last Name:CASTELLVI
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 1:1919 W SWANN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2417
Mailing Address - Country:US
Mailing Address - Phone:813-254-7079
Mailing Address - Fax:316-253-1029
Practice Address - Street 1:1919 W SWANN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2404
Practice Address - Country:US
Practice Address - Phone:813-254-7079
Practice Address - Fax:813-443-8164
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51403208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046855000Medicaid
FLCU086ZMedicare PIN
FL046855000Medicaid