Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 20548 | AZ |
Y | 208600000X | Surgeon | 20548 | AZ |
NPI | 1003836644 |
---|---|
Provider Name | Charles E Castillo |
First Address | Phoenix, AZ 85004-1303 |
Second Address | Phoenix, AZ 85004-1303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 05/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107971 | (05) | AZ |
F20827 | (02) | AZ |