Provider Demographics
NPI:1740269851
Name:CASTILLO-PLAZA, JUAN ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:CASTILLO-PLAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17900 NW 5TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2809
Mailing Address - Country:US
Mailing Address - Phone:954-437-3756
Mailing Address - Fax:954-442-8288
Practice Address - Street 1:17900 NW 5TH ST STE 201
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2809
Practice Address - Country:US
Practice Address - Phone:954-437-3756
Practice Address - Fax:954-442-8288
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56179207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22609Medicare UPIN
FL08764ZMedicare ID - Type Unspecified