Organization
PERSONALIZED HEMATOLOGY-ONCOLOGY OF WAKE FOREST PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUMINITA CASTILLOS PHD, MBA (PRACTICE MANAGER)
(919) 556-2907
Entity
Organization
Contact information
Practice address
11635 NORTH PARK DRIVE, WAKE FOREST, NC 27587-6298
(919) 556-2907
(919) 435-1060
Mailing address
11635 NORTH PARK DRIVE, SUITE 250, WAKE FOREST, NC 27587-6298
(919) 825-4637
(919) 435-1060
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200400833
NC
207RH0003X
Hematology & Oncology Physician
Primary
200400833
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137UC
BCBS
NC
05
—
89137UC
—
NC
Enumeration date
04/27/2012
Last updated
07/05/2012
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