Provider Demographics
NPI:1487764387
Name:CASTILLO, CAROLYN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARIE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 26028
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:505-262-9205
Mailing Address - Fax:505-342-8401
Practice Address - Street 1:9501 PASEO DEL NORTE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2998
Practice Address - Country:US
Practice Address - Phone:505-262-9205
Practice Address - Fax:505-342-8401
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9912207R00000X
NM88-136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00011528Medicaid
TX2067340-01Medicaid
8L8793OtherMEDICARE