Provider Demographics
NPI:1366894586
Name:CASTRO, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 MIAMI LAKES DR STE 415
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2704
Mailing Address - Country:US
Mailing Address - Phone:786-594-3963
Mailing Address - Fax:786-497-3903
Practice Address - Street 1:6625 MIAMI LAKES DR STE 415
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2704
Practice Address - Country:US
Practice Address - Phone:786-594-3963
Practice Address - Fax:786-497-3903
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21942251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health