Healthcare Provider Details

I. General information

NPI: 1124791355
Provider Name (Legal Business Name): JULEIDY CASTRO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 09/26/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7867 N KENDALL DR STE 130
MIAMI FL
33156-7736
US

IV. Provider business mailing address

7459 NW 178TH TER
HIALEAH FL
33015-8434
US

V. Phone/Fax

Practice location:
  • Phone: 305-598-1555
  • Fax:
Mailing address:
  • Phone: 786-493-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9114872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: