MEDICARE: BRISEIDA CASTA MD P.A

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	208000000X	Pediatrics Physician	ME74512	FL

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	:	1447657051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISEIDA CASTA MD P.A

Provider Business Mailing Address
First Line	:	2731 EXECUTIVE PARK DR
Second Line	:	SUITE #3
City	:	WESTON
State	:	FL
Zip	:	33331-3657
Country	:	US
Telephone Number	:	954-389-1064
Fax Number	:	954-389-3541

Provider Business Practice Location Address
First Line	:	2731 EXECUTIVE PARK DR
Second Line	:	SUITE #3
City	:	WESTON
State	:	FL
Zip	:	33331-3657
Country	:	US
Telephone Number	:	954-389-1064
Fax Number	:	954-389-3541

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRISEIDA CASTA
Credential	:	M.D
Telephone Number	:	954-389-1064

Provider Enumeration Date	:	11/25/2014
Last Update Date	:	11/25/2014

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