Provider Demographics
NPI:1760689400
Name:CASTILLO, MARTA ANISIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:ANISIA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5403 NW 20TH CT APT C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2179
Mailing Address - Country:US
Mailing Address - Phone:786-282-0147
Mailing Address - Fax:
Practice Address - Street 1:7765 S COUNTY ROAD 231
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054
Practice Address - Country:US
Practice Address - Phone:386-496-6121
Practice Address - Fax:386-496-6083
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN219208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16,111OtherP.RICO LICENSE
FLACN 219OtherAREACRITICAL NEED LICENSE
FLBC9501900OtherDEA LICENSE