1487795472 NPI number — DR. JACQUELINE GARCIA CASTELLANOS DMD

Table of content: DR. JACQUELINE GARCIA CASTELLANOS DMD (NPI 1487795472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487795472 NPI number — DR. JACQUELINE GARCIA CASTELLANOS DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA CASTELLANOS
Provider First Name:
JACQUELINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1487795472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12001 SW 128TH CT STE 103
Provider Second Line Business Mailing Address:
KENDALLWOOD OFFICE PARK II
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33186-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-279-6400
Provider Business Mailing Address Fax Number:
305-403-8704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12001 SW 128TH CT STE 103
Provider Second Line Business Practice Location Address:
KENDALLWOOD OFFICE PARK II
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33186-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-279-6400
Provider Business Practice Location Address Fax Number:
305-403-8704
Provider Enumeration Date:
02/11/2007

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: 1223G0001X , with the licence number:  DN14574 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 114229000 . 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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