1821046285 NPI number — DR. MAYRA M. CASTA M.D.

Table of content: DR. MAYRA M. CASTA M.D. (NPI 1821046285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821046285 NPI number — DR. MAYRA M. CASTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTA
Provider First Name:
MAYRA
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1821046285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6675 WESTWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 475
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32821-8061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-845-0330
Provider Business Mailing Address Fax Number:
888-972-1752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 N HABANA AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-7116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-444-9599
Provider Business Practice Location Address Fax Number:
813-513-8510
Provider Enumeration Date:
05/05/2006

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: 208D00000X , with the licence number:  ACN896 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: 14334 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1508132 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01814157 . This is a "SIMPLY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P1051219 . This is a "FEEDOM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P983472 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: U1N7R . This is a "FLORIDA BLUE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1145745 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 113093300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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