1851810873 NPI number — FLORENCIA CASTELBLANCO

Table of content: FLORENCIA CASTELBLANCO (NPI 1851810873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851810873 NPI number — FLORENCIA CASTELBLANCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTELBLANCO
Provider First Name:
FLORENCIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851810873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 THOMAS JOHNSON DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-662-3808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
932 HUNGERFORD DR STE 18A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-1751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-327-4434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 210002130 . This is a "DISTRICT OF COLUMBIA DEPT. OF HEALTH: BOARD OF OCCUPATIONAL THERAPY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09813 . This is a "MARYLAND BOARD OF OCCUPATIONAL THERAPY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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