Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 64171 | WI |
Y | 2086S0129X | Vascular Surgeon | MD461094 | PA |
NPI | 1053624080 |
---|---|
Provider Name | Maria Camila Castello-Ramirez |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 01/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033109300001 | (05) | PA |
583073 | MEDICARE (01) | PA |