Healthcare Provider Details

I. General information

NPI: 1396464087
Provider Name (Legal Business Name): ELEANA DE CASTRO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13896 SW 56TH ST
MIAMI FL
33175-6021
US

IV. Provider business mailing address

1167 NW 124TH CT APT 205
MIAMI FL
33182-2449
US

V. Phone/Fax

Practice location:
  • Phone: 305-387-2415
  • Fax:
Mailing address:
  • Phone: 305-542-9031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: