Provider Demographics
NPI:1982854352
Name:LOPEZ DE CASTILLA KOSTER, DIEGO (MD MPH)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:LOPEZ DE CASTILLA KOSTER
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 NE 130TH LN STE 120
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3041
Mailing Address - Country:US
Mailing Address - Phone:425-899-5100
Mailing Address - Fax:
Practice Address - Street 1:12303 NE 130TH LN STE 120
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3041
Practice Address - Country:US
Practice Address - Phone:425-899-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-02895207RI0200X
WAMD6033975207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1982854352Medicaid