Provider Demographics
NPI:1841529443
Name:PSYCHMED MEDICAL GROUP LLC
Entity type:Organization
Organization Name:PSYCHMED MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALDES CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-643-2228
Mailing Address - Street 1:2901 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4305
Mailing Address - Country:US
Mailing Address - Phone:305-643-2228
Mailing Address - Fax:305-643-1014
Practice Address - Street 1:2901 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4305
Practice Address - Country:US
Practice Address - Phone:305-643-2228
Practice Address - Fax:305-643-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL191119OtherOCCUPATIONAL LICENSE