Provider Demographics
NPI:1033850573
Name:AYALA CASTRO, LINA MARIA (MD)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:MARIA
Last Name:AYALA CASTRO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-669-5873
Mailing Address - Fax:
Practice Address - Street 1:5680 N TOWER RD STE 120
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8024
Practice Address - Country:US
Practice Address - Phone:720-734-8816
Practice Address - Fax:720-405-4454
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0074793208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program