Healthcare Provider Details

I. General information

NPI: 1205304797
Provider Name (Legal Business Name): LEDUAR MORALES CASTILLO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 49TH ST
HIALEAH FL
33012-3709
US

IV. Provider business mailing address

21 W 49TH ST
HIALEAH FL
33012-3709
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-1458
  • Fax: 786-360-1567
Mailing address:
  • Phone: 786-360-1458
  • Fax: 786-360-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000113
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9427475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: