=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669767018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMILIO CASTANEDA MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2011
-----------------------------------------------------
Last Update Date | 07/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 202
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-3765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-239-0578
-----------------------------------------------------
Fax | 954-239-0582
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 202
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-3765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-239-0578
-----------------------------------------------------
Fax | 954-239-0582
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EMILIO CASTANEDA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-257-5117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------