Provider Demographics
NPI:1578521340
Name:CASTELLVI, MARIA LOURDES
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LOURDES
Last Name:CASTELLVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7215
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7215
Mailing Address - Country:US
Mailing Address - Phone:787-841-5111
Mailing Address - Fax:787-841-5111
Practice Address - Street 1:775 CALLE CAOBA
Practice Address - Street 2:CENTRO COMERCIAL LOS CAOBOS STE. 25
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2610
Practice Address - Country:US
Practice Address - Phone:787-841-5111
Practice Address - Fax:787-841-5111
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR041251OtherLA CRUZ AZUL DE PR
PR61618OtherMEDICAL CARD SYSTEM
PR902454OtherUNITED CONCORDIA
PR41491OtherTRIPLE S
PR7160048OtherHUMANA