Provider Demographics
NPI:1427291517
Name:CASTELLO, MARI TRINI (MD)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:TRINI
Last Name:CASTELLO
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 1:3588 SWORDFISH LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-3636
Mailing Address - Country:US
Mailing Address - Phone:787-485-5492
Mailing Address - Fax:
Practice Address - Street 1:3588 SWORDFISH LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-3636
Practice Address - Country:US
Practice Address - Phone:787-485-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17184208D00000X
FLACN 861208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice