MEDICARE: DR. JUAN ANTONIO CASTILLO-PLAZA 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	207V00000X	Obstetrics & Gynecology Physician	ME56179	FL

General Provider Information

NPI Number	:	1740269851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN ANTONIO CASTILLO-PLAZA MD

Provider Business Mailing Address
First Line	:	17900 NW 5TH ST STE 201
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-2809
Country	:	US
Telephone Number	:	954-437-3756
Fax Number	:	954-442-8288

Provider Business Practice Location Address
First Line	:	17900 NW 5TH ST STE 201
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-2809
Country	:	US
Telephone Number	:	954-437-3756
Fax Number	:	954-442-8288

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	11/16/2007

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Directions to “ DR. JUAN ANTONIO CASTILLO-PLAZA MD” Practice Location

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