Provider Demographics
NPI:1669555009
Name:CASTILLO, VICTOR M (MT)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:M
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-1163
Mailing Address - Country:US
Mailing Address - Phone:787-826-2275
Mailing Address - Fax:787-826-5211
Practice Address - Street 1:48 CALLE 65 INFANTERIA
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2946
Practice Address - Country:US
Practice Address - Phone:787-826-2275
Practice Address - Fax:787-826-5211
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR359246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR359OtherSTATE LICENSURE
PR0030876Medicare ID - Type Unspecified