Healthcare Provider Details

I. General information

NPI: 1992301881
Provider Name (Legal Business Name): JOSE E CASTRO GUEVARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16340 NW 59TH AVE
MIAMI LAKES FL
33014-5601
US

IV. Provider business mailing address

44 NW 136TH PL
MIAMI FL
33182-1900
US

V. Phone/Fax

Practice location:
  • Phone: 305-789-8889
  • Fax: 305-370-7288
Mailing address:
  • Phone: 915-271-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22106
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberACN1326
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: