Provider Demographics
NPI:1174104277
Name:LIVING THE DREAM 63 LLC
Entity type:Organization
Organization Name:LIVING THE DREAM 63 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-264-5998
Mailing Address - Street 1:3182 DUNBAR LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3362
Mailing Address - Country:US
Mailing Address - Phone:850-264-5998
Mailing Address - Fax:850-329-2195
Practice Address - Street 1:3182 DUNBAR LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-3362
Practice Address - Country:US
Practice Address - Phone:850-264-5998
Practice Address - Fax:850-329-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty