Provider Demographics
NPI:1356714661
Name:RODRIGUEZ CASTRO, IRELIS (MD)
Entity type:Individual
Prefix:
First Name:IRELIS
Middle Name:
Last Name:RODRIGUEZ CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 POND CT
Mailing Address - Street 2:STE 301 AND 302
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 POND CT
Practice Address - Street 2:STE 301 AND 302
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3234
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:818-337-1454
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19228208D00000X
FLACN881208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN881OtherMEDICAL LICENSE
FLFR5652284OtherDEA