Provider Demographics
NPI:1780739946
Name:ALLERGY & ASTHMA CARE CENTRE PA
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CARE CENTRE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-549-1398
Mailing Address - Street 1:4017 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7160
Mailing Address - Country:US
Mailing Address - Phone:239-549-1398
Mailing Address - Fax:239-542-7881
Practice Address - Street 1:8461 CYPRESS LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5187
Practice Address - Country:US
Practice Address - Phone:239-489-1398
Practice Address - Fax:239-482-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74018207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF23902Medicare UPIN
FLK1425GPMedicare PIN