Provider Demographics
NPI:1487332862
Name:VALDEZ, CASTULO JUNIOR (MD)
Entity type:Individual
Prefix:
First Name:CASTULO
Middle Name:JUNIOR
Last Name:VALDEZ
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 1:1611 NW 12 AVENUE
Mailing Address - Street 2:HOLTZ ET 2169
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-355-1122
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12 AVENUE
Practice Address - Street 2:HOLTZ ET 2169
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-355-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-03-21
Deactivation Date:2024-02-08
Deactivation Code:
Reactivation Date:2024-03-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program