Provider Demographics
NPI:1942236872
Name:CASTELLANO, DANIA (OWNER)
Entity Type:Individual
Prefix:MISS
First Name:DANIA
Middle Name:
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 SE 20TH RD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035
Mailing Address - Country:US
Mailing Address - Phone:305-380-1046
Mailing Address - Fax:
Practice Address - Street 1:4343 WEST FLEGLER ST
Practice Address - Street 2:#507
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-648-0832
Practice Address - Fax:305-648-0833
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-8013601488-4171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23-8013601488-4Medicare ID - Type UnspecifiedFL SALES TAX ID