Provider Demographics
NPI:1215243621
Name:CASTELLANOS MARTIN, MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CASTELLANOS MARTIN
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:URB. GARDEN HILLS
Mailing Address - Street 2:HA3 CALLE PASEO DEL PARQUE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2911
Mailing Address - Country:US
Mailing Address - Phone:787-632-8111
Mailing Address - Fax:
Practice Address - Street 1:80100 CALLE MUNOZ RIVERA ESQ. MOLINILLO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-6179
Practice Address - Country:US
Practice Address - Phone:787-626-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18725207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18,725OtherPERMANENT