Healthcare Provider Details

I. General information

NPI: 1003569807
Provider Name (Legal Business Name): ERICK UNLIMITED II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3746 W 12TH AVE
HIALEAH FL
33012-4126
US

IV. Provider business mailing address

3746 W 12TH AVE
HIALEAH FL
33012-4126
US

V. Phone/Fax

Practice location:
  • Phone: 305-992-0837
  • Fax:
Mailing address:
  • Phone: 786-600-7560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICK CASTRO
Title or Position: OWNER
Credential:
Phone: 786-447-2391