Healthcare Provider Details

I. General information

NPI: 1578525630
Provider Name (Legal Business Name): JUAN LINO CASTRO GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. JUAN LINO CASTRO

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MACCORKLE AVE SE
CHARLESTON WV
25304-1334
US

IV. Provider business mailing address

3360 S ATLANTIC AVE APT 208
COCOA BEACH FL
32931-1900
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8380
  • Fax:
Mailing address:
  • Phone: 213-266-3047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME73059
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME73059
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME73059
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2022-00110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: