Provider Demographics
NPI:1124237524
Name:CASTRO, KENIA (MD)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4108
Mailing Address - Country:US
Mailing Address - Phone:305-519-4916
Mailing Address - Fax:305-412-6686
Practice Address - Street 1:4160 W 16TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5853
Practice Address - Country:US
Practice Address - Phone:305-690-0332
Practice Address - Fax:786-648-4409
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1012592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000218200Medicaid