Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 021034 | PR |
NPI | 1033696802 |
---|---|
Provider Name | Cristina P Castillo Mieses |
First Address | Carolina, PR 00986-7601 |
Second Address | Rio Grande, PR 00745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2018 |
Last Update Date | 25/07/2018 |