Provider Demographics
NPI:1982854352
Name:LOPEZ DE CASTILLA KOSTER, DIEGO (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:LOPEZ DE CASTILLA KOSTER
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:
Other - Last Name:LOPEZ DE CASTILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12303 NE 130TH LN STE CORAL120
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-5100
Practice Address - Fax:425-899-5105
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD6033975207RI0200X
NC2023-02895207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1982854352Medicaid