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: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON
SAN JUAN PR
00917-5032
US

IV. Provider business mailing address

4811 HAINES RD N
ST PETERSBURG FL
33714-3239
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax: 939-422-0814
Mailing address:
  • Phone: 813-562-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: