Provider Demographics
NPI:1124425277
Name:CASTILLO LORA, LUZ ELENA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ELENA
Last Name:CASTILLO LORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 BROADWAY
Mailing Address - Street 2:APT 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4024
Mailing Address - Country:US
Mailing Address - Phone:347-707-9668
Mailing Address - Fax:
Practice Address - Street 1:4395 BROADWAY
Practice Address - Street 2:APT 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4024
Practice Address - Country:US
Practice Address - Phone:347-707-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14-615246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant