MEDICARE: LAS TAZITAS CANTINAS CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366149023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS TAZITAS CANTINAS CORP

Provider Business Mailing Address
First Line	:	7821 NW 174TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3619
Country	:	US
Telephone Number	:	786-586-6033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 W 33RD PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4514
Country	:	US
Telephone Number	:	786-586-6033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ISMAEL CASTILLA
Credential	:
Telephone Number	:	786-586-6033

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	02/20/2025

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Directions to “LAS TAZITAS CANTINAS CORP ” Practice Location

Language	Start Address	Practice Location

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