Active NPI
Odalis Castellon, PHYSICIAN ASSISTANT
- Surgical Physician Assistant
- Hollywood, FL
National Provider Identifier
1306120746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA9101779
- Practice address
- 3449 Johnson Street
Hollywood, FL 33021 - Phone
- (954) 964-4113
- Fax
- (954) 963-8121
- NPI assigned
- Oct 4, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PA9101779 | FL | Primary |
Addresses
Primary practice location
3449 Johnson Street
Hollywood, FL 33021
Mailing address
3449 Johnson Street
Hollywood, FL 33021
Phone (954) 964-4113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9101779 | FL | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1306120746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3449 JOHNSON STREET",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "33021",
"telephone_number": "954-964-4113",
"fax_number": "954-963-8121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3449 JOHNSON STREET",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "33021",
"telephone_number": "954-964-4113",
"fax_number": "954-963-8121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASTELLON",
"first_name": "ODALIS",
"name_prefix": "Mrs.",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-04",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "FL",
"license": "PA9101779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.