Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME105064 | FL |
Y | 111NI0900X | Internist | ME105064 | FL |
NPI | 1003058330 |
---|---|
Provider Name | Ms. Madeline De Los Milagros Castro |
First Address | Miami, FL 33137-2706 |
Second Address | Miami, FL 33128-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 22/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001445500 | (05) | FL |
C04192 | MEDICARE PTAN (01) | FL |