MEDICARE: CARLOS CASTRO CRNA

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	367500000X	Certified Registered Nurse Anesthetist	26NR10265700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376646703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS CASTRO CRNA

Provider Business Mailing Address
First Line	:	PO BOX 7238
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-0938
Country	:	US
Telephone Number	:	201-566-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 76TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5504
Country	:	US
Telephone Number	:	201-566-3991
Fax Number	:

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	02/22/2012

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Directions to “ CARLOS CASTRO CRNA” Practice Location

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