1922255876 NPI number — LUIS A CASTRO VELEZ MD

Table of content: LUIS A CASTRO VELEZ MD (NPI 1922255876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922255876 NPI number — LUIS A CASTRO VELEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTRO VELEZ
Provider First Name:
LUIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTRO VELEZ
Provider Other First Name:
LUIS
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922255876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PARQUE MONTEBELLO
Provider Second Line Business Mailing Address:
F20 CALLE 2
Provider Business Mailing Address City Name:
TRUJILLO ALTO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00976-2868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-550-6162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO INTERNACIONAL DE MERCADEO
Provider Second Line Business Practice Location Address:
SUITE 303 AVE. LOS CANOS EXQ 28 KM 0.0
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00968-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-277-0847
Provider Business Practice Location Address Fax Number:
787-277-0942
Provider Enumeration Date:
08/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  27631 R , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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