Provider Demographics
NPI:1558881581
Name:CASTILLO HERNANDEZ, ISABEL CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:CRISTINA
Last Name:CASTILLO HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S BROAD ST UNIT 201B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-5026
Mailing Address - Country:US
Mailing Address - Phone:215-510-0029
Mailing Address - Fax:215-456-3436
Practice Address - Street 1:4500-10
Practice Address - Street 2:APT 201B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124
Practice Address - Country:US
Practice Address - Phone:215-510-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT213865390200000X
PAMD470783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA126551665001OtherINDEPENDENCE IS