Provider Demographics
NPI:1841228418
Name:DURAN CASTRO, OLGA LUCIA
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:LUCIA
Last Name:DURAN CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S POINTE DR
Mailing Address - Street 2:APT 706
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4767
Mailing Address - Country:US
Mailing Address - Phone:305-606-1027
Mailing Address - Fax:
Practice Address - Street 1:50 S POINTE DR
Practice Address - Street 2:APT 706
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4767
Practice Address - Country:US
Practice Address - Phone:305-606-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN482682085R0202X, 2085R0204X
FLME1212922085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0151487Medicaid
MN1046626OtherPREFERRED ONE
MN16-03962OtherMEDICA CHOICE
IA0717306Medicaid
MN743T6DUOtherBCBS
MN915700000Medicaid
MN16-02032OtherMEDICA PRIMARY
MN915700000Medicaid
MT0151487Medicaid