Provider Demographics
NPI:1053169557
Name:CASTRO MARTI, MARJOLYS
Entity type:Individual
Prefix:
First Name:MARJOLYS
Middle Name:
Last Name:CASTRO MARTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11710 NW SOUTH RIVER DR APT 304
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1165
Mailing Address - Country:US
Mailing Address - Phone:972-815-7554
Mailing Address - Fax:
Practice Address - Street 1:11710 NW SOUTH RIVER DR APT 304
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1165
Practice Address - Country:US
Practice Address - Phone:972-815-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily