Provider Demographics
NPI:1902958580
Name:CASTRO, IRIS M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:M
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51143
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1143
Mailing Address - Country:US
Mailing Address - Phone:787-269-5150
Mailing Address - Fax:787-269-5150
Practice Address - Street 1:EDIF MEDICO
Practice Address - Street 2:#73 CALLE SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5041
Practice Address - Country:US
Practice Address - Phone:787-269-5150
Practice Address - Fax:787-269-5150
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2734103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical