Provider Demographics
NPI:1558669713
Name:CASTANON, ILIA E (RN)
Entity Type:Individual
Prefix:MRS
First Name:ILIA
Middle Name:E
Last Name:CASTANON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 11891
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9579
Mailing Address - Country:US
Mailing Address - Phone:939-645-5989
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 11891
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9579
Practice Address - Country:US
Practice Address - Phone:939-645-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR025691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse