Provider Demographics
NPI:1609766542
Name:CASTILLO VASQUEZ, GELDA ALTAGRACIA
Entity type:Individual
Prefix:
First Name:GELDA
Middle Name:ALTAGRACIA
Last Name:CASTILLO VASQUEZ
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 1:1135 COBBLESTONE CIR APT B
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5595
Mailing Address - Country:US
Mailing Address - Phone:321-830-4581
Mailing Address - Fax:
Practice Address - Street 1:9905 58TH AVE APT 2I
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3710
Practice Address - Country:US
Practice Address - Phone:321-830-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty