Provider Demographics
NPI:1720222458
Name:CASTILLA, MARIA FERNANDA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:CASTILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25097 OLYMPIA AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3914
Mailing Address - Country:US
Mailing Address - Phone:540-981-8280
Mailing Address - Fax:
Practice Address - Street 1:21260 OLEAN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6742
Practice Address - Country:US
Practice Address - Phone:941-235-9361
Practice Address - Fax:941-235-9362
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME121783208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program