Provider Demographics
NPI:1982677654
Name:TORRES, GILBERTO CASTILLO (PA)
Entity Type:Individual
Prefix:
First Name:GILBERTO
Middle Name:CASTILLO
Last Name:TORRES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4815
Mailing Address - Country:US
Mailing Address - Phone:405-840-9999
Mailing Address - Fax:405-840-9998
Practice Address - Street 1:4601 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4815
Practice Address - Country:US
Practice Address - Phone:405-840-9999
Practice Address - Fax:405-840-9998
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125460CMedicaid
OK100125460CMedicaid
OKS23851Medicare UPIN