Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 0101266473 | VA |
N | 207RI0200X | Infectious Disease | 200100655 | NC |
NPI | 1083706568 |
---|---|
Provider Name | Emma Castillo |
First Address | Williamsburg, VA 23188-5725 |
Second Address | Williamsburg, VA 23188-5725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129XG | BCBS (01) | NC |
4213840 | CIGNA (01) | NC |
5900019 | (05) | NC |
H54437 | (02) | NC |
P00671694 | MEDICARE RAILROAD (01) |