Provider Demographics
NPI:1518123322
Name:CASTRO, MAYRA (PA)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12781 SW 42ND ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3437
Mailing Address - Country:US
Mailing Address - Phone:305-229-3990
Mailing Address - Fax:305-229-3880
Practice Address - Street 1:12781 SW 42ND ST
Practice Address - Street 2:SUITE H
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3437
Practice Address - Country:US
Practice Address - Phone:305-229-3990
Practice Address - Fax:305-229-3880
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCI329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant