=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811041114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUSTINIANO CASTRO - MONTALVO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 02/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB GARCIA CALLE ANDRES GARCIA NO. 53
-----------------------------------------------------
City | ARECIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-817-4973
-----------------------------------------------------
Fax | 787-817-4997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 CARR 693 PMB 371
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-817-4973
-----------------------------------------------------
Fax | 787-817-4997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 10600
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------