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General NPI Number Information
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NPI Number | 1326231655
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Entity Type | Individual
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Provider Name | JERRY REYES CASTRO M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 341 S. MARINE CORP DR. - SUITE 104
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City | TAMUNING
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State | GU
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Zip | 98913
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Country | US
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Telephone | 671-989-1368
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Fax | 671-989-2360
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Provider Business Mailing Address
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Address Line | 341 S. MARINE CORP DRIVE - SUITE 104
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City | TAMUNING
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State | GU
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Zip | 96913
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Country | US
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Telephone | 671-989-1368
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Fax | 971-989-2360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 236169
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | M-1744
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License Number State | GU
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