Provider Demographics
NPI:1205304797
Name:MORALES CASTILLO, LEDUAR (APRN)
Entity type:Individual
Prefix:
First Name:LEDUAR
Middle Name:
Last Name:MORALES CASTILLO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 NW 176TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-3549
Mailing Address - Country:US
Mailing Address - Phone:786-612-1594
Mailing Address - Fax:
Practice Address - Street 1:11255 SW 211TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2240
Practice Address - Country:US
Practice Address - Phone:305-254-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9427475363LF0000X
FL11000113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily