Healthcare Provider Details

I. General information

NPI: 1194024695
Provider Name (Legal Business Name): ANNIE L CASTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 SW 67TH AVE
MIAMI FL
33144-4754
US

IV. Provider business mailing address

175 WESTWARD DR.
MIAMI SPRING FL
33166
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2573
  • Fax: 786-353-2587
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME117614
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME117614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: