Provider Demographics
NPI:1326077967
Name:CASTELLANOS, JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 W 68TH ST
Mailing Address - Street 2:SUITE #304
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6889
Mailing Address - Country:US
Mailing Address - Phone:305-824-3604
Mailing Address - Fax:305-826-1300
Practice Address - Street 1:2387 W 68TH ST
Practice Address - Street 2:SUITE #304
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6889
Practice Address - Country:US
Practice Address - Phone:305-824-3604
Practice Address - Fax:305-826-1300
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCT753ZMedicare UPIN