Provider Demographics
NPI:1598986846
Name:DELCASTILLO, JOSE (BCP ABC BOC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:DELCASTILLO
Suffix:
Gender:M
Credentials:BCP ABC BOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4533
Mailing Address - Country:US
Mailing Address - Phone:305-649-8700
Mailing Address - Fax:305-649-8709
Practice Address - Street 1:3181 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4533
Practice Address - Country:US
Practice Address - Phone:305-649-8700
Practice Address - Fax:305-649-8709
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORF 122246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM0758OtherBCBS
FL0538520001Medicare ID - Type Unspecified