Provider Demographics
NPI:1750413514
Name:CASTELLVI, GUILLERMO ORESTES (MD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ORESTES
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 320502
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2502
Mailing Address - Country:US
Mailing Address - Phone:813-496-9900
Mailing Address - Fax:813-496-9920
Practice Address - Street 1:11033 COUNTRYWAY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2628
Practice Address - Country:US
Practice Address - Phone:813-496-9900
Practice Address - Fax:813-496-9920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 44641208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL229183OtherAVMED
FL04050OtherBCBS OF FL
FL010022933OtherRAILROAD MEDICARE
FL259319000Medicaid
FL04050OtherBCBS OF FL
FLD20865Medicare UPIN