Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | ME92752 | FL |
NPI | 1194751602 |
---|---|
Provider Name | Dr. Julio Cesar Castellan |
First Address | Sunrise, FL 33323-2865 |
Second Address | Hollywood, FL 33021-5421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274007900 | (05) | FL |
30673 | BLUE SHIELD (01) | FL |
F69290 | (02) |