Provider Demographics
NPI:1649547597
Name:CASTILLO, JACQUELIN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELIN
Middle Name:ELIZABETH
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2027
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:260 US HIGHWAY 181 N
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3136
Practice Address - Country:US
Practice Address - Phone:830-393-8222
Practice Address - Fax:855-278-4529
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327555402Medicaid
TXP3865OtherTX LICENSE
TX298574ZLM2Medicare PIN