Provider Demographics
NPI:1063754224
Name:CASTILLO MORALES, AIXA (PHD)
Entity type:Individual
Prefix:DR
First Name:AIXA
Middle Name:
Last Name:CASTILLO MORALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RIO PIEDRAS VLY
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1426
Mailing Address - Country:US
Mailing Address - Phone:787-598-0719
Mailing Address - Fax:
Practice Address - Street 1:5 RIO PIEDRAS VLY
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-1426
Practice Address - Country:US
Practice Address - Phone:787-598-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1987103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1063754224OtherPSICOLOGA