=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063143287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERICK UNLIMITED II, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2022
-----------------------------------------------------
Last Update Date | 06/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 875 E 41ST ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-477-2391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 875 E 41ST ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-477-2391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES, OWNER
-----------------------------------------------------
Name | MR. ERICK CASTRO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-477-2391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------