Provider Demographics
NPI:1962404749
Name:CASTILLOVEITIA, PEDRO DIONISIO (MD)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:DIONISIO
Last Name:CASTILLOVEITIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 RUTA 474
Mailing Address - Street 2:BARRIO GALATEO BAJO
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3948
Mailing Address - Country:US
Mailing Address - Phone:787-818-5593
Mailing Address - Fax:787-818-5594
Practice Address - Street 1:CALLE BARBOSA NUMERO 325
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4104
Practice Address - Country:US
Practice Address - Phone:787-818-5593
Practice Address - Fax:787-818-5594
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10728208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF47619Medicare UPIN
PR0082944Medicare ID - Type Unspecified