=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427199652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENES CASTOR MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3933 HAVERHILL RD N STE 115
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33417-7424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-478-7659
-----------------------------------------------------
Fax | 877-317-6158
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1525 STONEHAVEN ESTATES DR
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-478-7659
-----------------------------------------------------
Fax | 877-317-6158
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RENES CASTOR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-478-7659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME43329
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------