Provider Demographics
NPI:1497830640
Name:CASTELLANOS, ANA MARIETTA (MD, PA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIETTA
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:MARIETTA
Other - Middle Name:
Other - Last Name:CASTELLANOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1450 MADRUGA AVE
Mailing Address - Street 2:#201
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-663-0213
Mailing Address - Fax:305-663-1856
Practice Address - Street 1:1450 MADRUGA AVE
Practice Address - Street 2:#201
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146
Practice Address - Country:US
Practice Address - Phone:305-663-0213
Practice Address - Fax:305-663-0213
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME803352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63647Medicare UPIN