Provider Demographics
NPI:1750514568
Name:CASTELLANOS, GIANNIE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:GIANNIE
Middle Name:MARIE
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4204
Mailing Address - Country:US
Mailing Address - Phone:786-251-5834
Mailing Address - Fax:
Practice Address - Street 1:3751 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4204
Practice Address - Country:US
Practice Address - Phone:786-251-5834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist