Organization Name: | AGENIXED CORPORATION |
NPI Number: | 1700095130 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAFAEL A CASTRO (PRESIDENT) |
Mailing Address: | 1001 Se Ocean Blvd Suite 105 Stuart |
State: | FL US |
Postal Code: | 349962511 |
Phone Number: | 7722886558 |
Fax Number: | 7722886537 |
NPI Enumeration Date: | 05/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME25001 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |