Healthcare Provider Details

I. General information

NPI: 1295885408
Provider Name (Legal Business Name): ALBA S CASTRO COLON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOS ANGELES CALLE CELESTIAL 2392A
CAROLINA PR
00979-1655
US

IV. Provider business mailing address

LOS ANGELES CALLE CELESTIAL 2392A
CAROLINA PR
00979-1655
US

V. Phone/Fax

Practice location:
  • Phone: 787-791-1318
  • Fax: 787-791-1318
Mailing address:
  • Phone: 787-791-1318
  • Fax: 787-791-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number887
License Number StatePR

VIII. Authorized Official

Name: MRS. ALBA S CASTRO
Title or Position: PROPRIETRESS
Credential: M.T.
Phone: 787-791-1318