1376034819 NPI number — MS. ISABEL CASTANO MS

Table of content: MS. ISABEL CASTANO MS (NPI 1376034819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376034819 NPI number — MS. ISABEL CASTANO MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTANO
Provider First Name:
ISABEL
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS
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:
1376034819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 NW 14TH ST RM 1213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33136-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-243-6660
Provider Business Mailing Address Fax Number:
305-243-3501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 NW 14TH ST # 1209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-978-5885
Provider Business Practice Location Address Fax Number:
305-243-3501
Provider Enumeration Date:
05/21/2018

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: 1041S0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 690909496 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".