Provider Demographics
NPI:1659945384
Name:CHAO CASTILLO, MARCELO
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:CHAO CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW 107TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2798
Mailing Address - Country:US
Mailing Address - Phone:305-964-5381
Mailing Address - Fax:
Practice Address - Street 1:13335 SW 124TH ST STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7513
Practice Address - Country:US
Practice Address - Phone:305-964-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management