Provider Demographics
NPI:1710556618
Name:CASTILLO BASSO, CARLOS CESAR (APRN,FNP)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:CESAR
Last Name:CASTILLO BASSO
Suffix:
Gender:M
Credentials:APRN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9331 SW 6TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2270
Mailing Address - Country:US
Mailing Address - Phone:786-234-8810
Mailing Address - Fax:
Practice Address - Street 1:9331 SW 6TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2270
Practice Address - Country:US
Practice Address - Phone:786-234-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012978207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine