Provider Demographics
NPI:1669961579
Name:CASTILLO, MINNA ROSYE GEORGE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MINNA
Middle Name:ROSYE GEORGE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MINNA
Other - Middle Name:ROSYE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-2089
Mailing Address - Fax:718-920-2058
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-2985
Practice Address - Fax:718-920-2058
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant