Provider Demographics
NPI:1811440589
Name:CASTILLOVEITIA VEGA, GLORIA LUZ
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:LUZ
Last Name:CASTILLOVEITIA VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 CALLE AURORA APT 521
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1598
Mailing Address - Country:US
Mailing Address - Phone:787-709-3533
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CASIA 116A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00717-3201
Practice Address - Country:US
Practice Address - Phone:787-709-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3160172084P0800X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry