=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679843320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADRIANA M CASTRO MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2012
-----------------------------------------------------
Last Update Date | 06/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9220 SW 72ND ST SUITE 102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-275-1700
-----------------------------------------------------
Fax | 305-275-5008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9220 SW 72ND ST SUITE 102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-275-1700
-----------------------------------------------------
Fax | 305-275-5008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIVISION MANAGER
-----------------------------------------------------
Name | PROF. ANTHONY F D'ASCOLI II
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 305-275-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME0056180
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------