Healthcare Provider Details

I. General information

NPI: 1740070036
Provider Name (Legal Business Name): JORGE LUIS CASTRO MARRERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 CALLE MAYAGUEZ APT 411
SAN JUAN PR
00917-5138
US

IV. Provider business mailing address

81 CALLE MAYAGUEZ APT 411
SAN JUAN PR
00917-5138
US

V. Phone/Fax

Practice location:
  • Phone: 813-562-2904
  • Fax:
Mailing address:
  • Phone: 813-562-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25060
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: