Provider Demographics
NPI:1952419467
Name:CASTILLO, JOEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:CASTILLO
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:CALLE 1 BLOQUE 1 #13
Mailing Address - Street 2:URB. SIERRA BAYAMON,
Mailing Address - City:BAYAMON,
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:786-382-1688
Mailing Address - Fax:
Practice Address - Street 1:2004 AVE BORINQUEN
Practice Address - Street 2:BO OBRERO
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00915-3824
Practice Address - Country:US
Practice Address - Phone:787-268-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16606208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice