Healthcare Provider Details

I. General information

NPI: 1881958908
Provider Name (Legal Business Name): NELSON ALEXANDER CASTANEDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OPA LOCKA BLVD
OPA LOCKA FL
33054-3528
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 786-535-7200
  • Fax: 786-535-7294
Mailing address:
  • Phone: 786-535-7200
  • Fax: 786-535-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127594
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberME 127594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: