Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95008550 | CA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95008550 | CA |
NPI | 1013596907 |
---|---|
Provider Name | Paola Castillo Gomez |
First Address | Miami, FL 33145-2313 |
Second Address | Miami, FL 33145-2313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2021 |
Last Update Date | 07/04/2021 |