Healthcare Provider Details

I. General information

NPI: 1730376922
Provider Name (Legal Business Name): IVAN IGNACIO CASTELLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE WEST WING 279
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1150 NW 14TH ST # ST511
MIAMI FL
33136-2137
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-7878
  • Fax:
Mailing address:
  • Phone: 305-243-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME103365
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME103365
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: