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General NPI Number Information
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NPI Number | 1649299652
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Entity Type | Individual
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Provider Name | IVAN DARIO CASTANO M.D
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 4204 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4158
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Country | US
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Telephone | 305-556-3818
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Fax | 305-557-7675
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Provider Business Mailing Address
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Address Line | 4204 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-4158
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Country | US
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Telephone | 305-556-3818
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Fax | 305-557-7675
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0041641
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License Number State | FL
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