Healthcare Provider Details

I. General information

NPI: 1124944483
Provider Name (Legal Business Name): JOSE CARLOS DEL CASTILLO MIRANDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

2330 HOFFMAN ST APT 5J
BRONX NY
10458-8080
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6202
  • Fax:
Mailing address:
  • Phone: 718-209-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: