Basic Information
Provider Information
NPI: 1497109425
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTILLO
FirstName: DANIEL
MiddleName: FRANCISCO
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3333 BURNET AVE
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364415
FaxNumber: 5136367805
Practice Location
Address1: 3333 BURNET AVE ML2010
Address2: CHILDRENS HOSPITAL MEDICAL CENTER
City: CINCINNATI
State: OH
PostalCode: 45229
CountryCode: US
TelephoneNumber: 5136364415
FaxNumber: 5136367805
Other Information
ProviderEnumerationDate: 04/15/2016
LastUpdateDate: 06/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0206X35.136446OHY Allopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology

No ID Information.


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