Healthcare Provider Details

I. General information

NPI: 1649809443
Provider Name (Legal Business Name): CHARLES ALEXANDER CASTRO SOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 27 GG-11 URB. CANA
BAYAMON PR
00957
US

IV. Provider business mailing address

CALLE 27 GG-11 URB. CANA
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-300-7600
  • Fax:
Mailing address:
  • Phone: 787-300-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35964
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: