Provider Demographics
NPI:1700114527
Name:CASTELLVI, ANTONIO ORTELIO (MD,)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:ORTELIO
Last Name:CASTELLVI
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:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:1919 W SWANN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2404
Practice Address - Country:US
Practice Address - Phone:813-254-8055
Practice Address - Fax:813-443-8163
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014073800Medicaid
FL014073800Medicaid