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General NPI Number Information
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NPI Number | 1407083256
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Entity Type | Individual
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Provider Name | MAURICIO JOSE DE CASTRO PRETELT MD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 1200 CHILDRENS AVE STE 5D
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-4637
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Country | US
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Telephone | 405-271-4211
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Fax | 405-271-2263
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Provider Business Mailing Address
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Address Line | 541 N CORNICHE DU LAC
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City | COVINGTON
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State | LA
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Zip | 70433-7260
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Country | US
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Telephone | 813-253-9291
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Fax |
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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 | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number | 0101250567
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 46520
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | 0101250567
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License Number State | VA
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