Healthcare Provider Details

I. General information

NPI: 1528767050
Provider Name (Legal Business Name): CECILIA CASTOR GARCIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-7096
  • Fax: 305-585-8132
Mailing address:
  • Phone: 305-585-7096
  • Fax: 305-585-8132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11018275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: