MEDICARE: BRISEIDA CASTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME74512	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376531566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRISEIDA CASTA MD

Provider Business Mailing Address
First Line	:	2731 EXECUTIVE PARK DR
Second Line	:	SUITE 3
City	:	WESTON
State	:	FL
Zip	:	33331-3657
Country	:	US
Telephone Number	:	954-389-1064
Fax Number	:	954-389-3541

Provider Business Practice Location Address
First Line	:	2731 EXECUTIVE PARK DR
Second Line	:	SUITE 3
City	:	WESTON
State	:	FL
Zip	:	33331-3657
Country	:	US
Telephone Number	:	954-389-1064
Fax Number	:	954-389-3541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	06/13/2012

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Directions to “ BRISEIDA CASTA MD” Practice Location

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