Healthcare Provider Details

I. General information

NPI: 1225590060
Provider Name (Legal Business Name): ERIC GABRIEL ALICEA CASTRO MEDICAL STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLAS DE LA PLAYA #714
VEGA BAJA PUERTO RICO
00693
UM

IV. Provider business mailing address

VILLAS DE LA PLAYA #714
VEGA BAJA PUERTO RICO
00693
UM

V. Phone/Fax

Practice location:
  • Phone: 787-249-5697
  • Fax:
Mailing address:
  • Phone:
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: