Provider Demographics
NPI:1538422316
Name:CASTRO, PABLO R (MD)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:R
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 241011
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-9511
Mailing Address - Country:US
Mailing Address - Phone:209-339-7435
Mailing Address - Fax:209-333-3054
Practice Address - Street 1:1901 W KETTLEMAN LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4337
Practice Address - Country:US
Practice Address - Phone:209-334-8540
Practice Address - Fax:209-368-2885
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2016-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR12389208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12389OtherLICENSE