Healthcare Provider Details

I. General information

NPI: 1962668509
Provider Name (Legal Business Name): LUIS A CASTANEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LUIS A CASTANEDA MD

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 954-493-5005
  • Fax: 954-938-0957
Mailing address:
  • Phone: 800-243-3839
  • Fax: 954-839-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME111227
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57.021932
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: