Provider Demographics
NPI:1093095697
Name:RICARDO CASTRELLON MD PA
Entity Type:Organization
Organization Name:RICARDO CASTRELLON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRELLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-665-8730
Mailing Address - Street 1:6200 SUNSET DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4828
Mailing Address - Country:US
Mailing Address - Phone:305-665-8730
Mailing Address - Fax:305-665-8736
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 402
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-665-8730
Practice Address - Fax:305-665-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty