Provider Demographics
NPI:1447609888
Name:CASTELLON MEDICAL CENTER
Entity Type:Organization
Organization Name:CASTELLON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-431-6315
Mailing Address - Street 1:16371 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6044
Mailing Address - Country:US
Mailing Address - Phone:786-332-4991
Mailing Address - Fax:786-409-2037
Practice Address - Street 1:16371 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6044
Practice Address - Country:US
Practice Address - Phone:786-332-4991
Practice Address - Fax:786-409-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90692173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1902275183OtherNPI
FL1780666750Other1780666750