Provider Demographics
NPI:1558406033
Name:CASTELLINO, LAILA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAILA
Middle Name:MARIA
Last Name:CASTELLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAILA
Other - Middle Name:MARIA
Other - Last Name:FERNANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-590-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-089589207RI0200X
TXR9732207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2783484Medicaid
OH2783484Medicaid
OHP01330582Medicare PIN