Provider Demographics
NPI:1588605646
Name:CASTELLON, CELESTINO P (MD PA)
Entity Type:Individual
Prefix:
First Name:CELESTINO
Middle Name:P
Last Name:CASTELLON
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E 25TH ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-693-8381
Mailing Address - Fax:305-693-8373
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 507
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-693-8381
Practice Address - Fax:305-693-8373
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27922207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258031400Medicaid
FLDO8183Medicare UPIN
FL35152AMedicare ID - Type Unspecified