Healthcare Provider Details

I. General information

NPI: 1184064735
Provider Name (Legal Business Name): WARREN JOSE PERALTA CASTRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LAKE ELLENOR DR STE 700
ORLANDO FL
32809-4643
US

IV. Provider business mailing address

5900 LAKE ELLENOR DR STE 700
ORLANDO FL
32809-4643
US

V. Phone/Fax

Practice location:
  • Phone: 407-352-2542
  • Fax: 844-556-8650
Mailing address:
  • Phone: 407-352-2542
  • Fax: 844-556-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME128733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: