Provider Demographics
NPI:1841558236
Name:DE CASTRO, GUARIONEX R (MD)
Entity Type:Individual
Prefix:DR
First Name:GUARIONEX
Middle Name:R
Last Name:DE CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8260 W FLAGLER ST
Mailing Address - Street 2:1A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2069
Mailing Address - Country:US
Mailing Address - Phone:786-703-3484
Mailing Address - Fax:786-703-3486
Practice Address - Street 1:8260 W FLAGLER ST
Practice Address - Street 2:1A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2069
Practice Address - Country:US
Practice Address - Phone:786-703-3484
Practice Address - Fax:786-703-3486
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37331208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGX176ZOtherMEDICARE PTAN