Provider Demographics
NPI:1689888562
Name:CASTRO, DANIEL (PA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 NW 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5116
Mailing Address - Country:US
Mailing Address - Phone:954-753-9337
Mailing Address - Fax:954-753-9338
Practice Address - Street 1:2901 CORAL HILLS DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4146
Practice Address - Country:US
Practice Address - Phone:954-753-9337
Practice Address - Fax:954-753-9338
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant