Provider Demographics
NPI:1821046285
Name:CASTA, MAYRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:M
Last Name:CASTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6675 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8061
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:4700 N HABANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7116
Practice Address - Country:US
Practice Address - Phone:813-444-9599
Practice Address - Fax:813-513-8510
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLACN896208D00000X
PR14334208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508132OtherWELLCARE
FLP01814157OtherSIMPLY
FLP1051219OtherFEEDOM
FLP983472OtherOPTIMUM
FLU1N7ROtherFLORIDA BLUE
FL1145745OtherCAREPLUS