MEDICARE: PERALTA CASTRO LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1982378840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERALTA CASTRO LLC

Provider Business Mailing Address
First Line	:	1910 STANDING ROCK CIR
Second Line	:
City	:	OAKLAND
State	:	FL
Zip	:	34787-8120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 STANDING ROCK CIR
Second Line	:
City	:	OAKLAND
State	:	FL
Zip	:	34787-8120
Country	:	US
Telephone Number	:	347-364-1425
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WARREN PERALTA-CASTRO
Credential	:
Telephone Number	:	347-364-1425

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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