Basic Information
Provider Information
NPI: 1235115767
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTILLO
FirstName: PALOMITA
MiddleName: V.
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MUNRO AVE
Address2: HEALTH SERVICES DIVISION
City: CAPE MAY
State: NJ
PostalCode: 082045000
CountryCode: US
TelephoneNumber: 6098986610
FaxNumber: 6098986343
Practice Location
Address1: 1 MUNRO AVE
Address2: HEALTH SERVICES DIVISION
City: CAPE MAY
State: NJ
PostalCode: 082045000
CountryCode: US
TelephoneNumber: 6098986610
FaxNumber: 6098986343
Other Information
ProviderEnumerationDate: 12/16/2005
LastUpdateDate: 10/30/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171000000X  Y Other Service ProvidersMilitary Health Care Provider 

No ID Information.


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