MEDICARE: MRS. KALICHA CASTRO JORGE AF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	10088	PR

General Provider Information

NPI Number	:	1093223331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KALICHA CASTRO JORGE AF

Provider Business Mailing Address
First Line	:	BO DULCE 78 CALLE PRINCIPAL
Second Line	:	CAIMITO BAJO
City	:	SAN JUAN
State	:	PR
Zip	:	00926-0000
Country	:	US
Telephone Number	:	844-347-7806
Fax Number	:

Provider Business Practice Location Address
First Line	:	MARGINAL SAN ROBERTO 996
Second Line	:	PROFESSIONAL OFFICE PARK V
City	:	SAN JUAN
State	:	PR
Zip	:	00923-0000
Country	:	US
Telephone Number	:	844-347-7806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	01/22/2018

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