Provider Demographics
NPI:1558326470
Name:DECASTRO, MARIA TERESITA (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESITA
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-315-1535
Mailing Address - Fax:813-377-1394
Practice Address - Street 1:1721 BRANDON MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5018
Practice Address - Country:US
Practice Address - Phone:813-315-1535
Practice Address - Fax:813-377-1394
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1012182084N0400X
IL036.0992652084N0400X
FLOS 130602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI526551-03Medicaid
G64023Medicare UPIN
HI52655104Medicaid
HI00B0217956OtherHMSA BCBS
HIH52016Medicare PIN
HI0000217950OtherHMSA (KAISER)
HIH57608Medicare PIN