Provider Demographics
NPI:1922844497
Name:CASTILLO CASALLAS, YANETH (MD)
Entity type:Individual
Prefix:
First Name:YANETH
Middle Name:
Last Name:CASTILLO CASALLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3186 VIA POINCIANA APT 405
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1939
Mailing Address - Country:US
Mailing Address - Phone:786-260-9720
Mailing Address - Fax:
Practice Address - Street 1:3186 VIA POINCIANA
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1998
Practice Address - Country:US
Practice Address - Phone:786-260-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16919I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice