Provider Demographics
NPI:1821233966
Name:CASTILLO, LUIS CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:CARLOS
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:CARLOS
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3713 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3753
Mailing Address - Country:US
Mailing Address - Phone:561-649-4342
Mailing Address - Fax:561-246-4859
Practice Address - Street 1:3713 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3753
Practice Address - Country:US
Practice Address - Phone:561-649-4342
Practice Address - Fax:561-246-4859
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine