Healthcare Provider Details

I. General information

NPI: 1891614640
Provider Name (Legal Business Name): MICHELLE AZUCENA CASTRO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

3550 NW 97TH ST
MIAMI FL
33147-2239
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 786-208-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: