Healthcare Provider Details

I. General information

NPI: 1700095130
Provider Name (Legal Business Name): AGENIXED CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SE OCEAN BLVD SUITE 105
STUART FL
34996-2511
US

IV. Provider business mailing address

PO BOX 2380
PALM CITY FL
34991-7380
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-6558
  • Fax: 772-288-6537
Mailing address:
  • Phone: 772-288-6558
  • Fax: 772-288-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME 25001
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME25001
License Number StateFL

VIII. Authorized Official

Name: DR. RAFAEL A CASTRO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 772-288-6558