Healthcare Provider Details

I. General information

NPI: 1316044704
Provider Name (Legal Business Name): JOSE MANUEL CASTRO RODRIGUEZ M.D., F.A.C.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE SAN FRANCISCO SUITE 408, AVE DE DIEGO 369
RIO PIEDRAS PR
00923
US

IV. Provider business mailing address

MARBELLA 22 URB PASEO LAS BRISAS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-4100
  • Fax: 787-767-4119
Mailing address:
  • Phone: 787-755-2551
  • Fax: 787-767-4119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4176
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: