Healthcare Provider Details

I. General information

NPI: 1750156048
Provider Name (Legal Business Name): KATHERINE CASTELLANOS RODRIGUEZ APRN, FNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 06/03/2024
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 W 23RD ST
HIALEAH FL
33010-2211
US

IV. Provider business mailing address

19921 SW 117TH AVE
MIAMI FL
33177-4425
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-3312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: