Provider Demographics
NPI:1831135235
Name:CASTELLANOS, JOSE V (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:V
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 13TH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2350
Mailing Address - Country:US
Mailing Address - Phone:561-391-5993
Mailing Address - Fax:561-391-5956
Practice Address - Street 1:900 NW 13TH STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2350
Practice Address - Country:US
Practice Address - Phone:561-391-5993
Practice Address - Fax:561-391-5956
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 74832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42719YOtherMEDICARE
FLA61326Medicare UPIN