Provider Demographics
NPI:1780064428
Name:NAPLES WEST GROUP
Entity type:Organization
Organization Name:NAPLES WEST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAIRELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:239-252-5332
Mailing Address - Street 1:5051 CASTELLO DR STE 41
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8984
Mailing Address - Country:US
Mailing Address - Phone:239-692-4428
Mailing Address - Fax:
Practice Address - Street 1:5051 CASTELLO DR STE 41
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8984
Practice Address - Country:US
Practice Address - Phone:239-692-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5051CASTELLO207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5051CASTELLOOtherCOMERCIAL OBAMACARE