Provider Demographics
NPI:1720057151
Name:CASTILLO-BACA, ERICK (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:CASTILLO-BACA
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:D31 CALLE TREVI
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5021
Mailing Address - Country:US
Mailing Address - Phone:788-308-3388
Mailing Address - Fax:
Practice Address - Street 1:9600 SW 8TH ST STE 18
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2947
Practice Address - Country:US
Practice Address - Phone:305-266-0600
Practice Address - Fax:305-266-2040
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15247208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN1148OtherFLORIDA DEPARMENT OF HEALTH
1720057151OtherCMS