Provider Demographics
NPI:1548368459
Name:CASTRO, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CALLE JUANITA
Mailing Address - Street 2:URB. BELLAS LOMAS
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7568
Mailing Address - Country:US
Mailing Address - Phone:787-834-2994
Mailing Address - Fax:787-986-7070
Practice Address - Street 1:CONDOMINIO LA PALMA PERAL #14
Practice Address - Street 2:SUITE 2-G
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-2994
Practice Address - Fax:787-986-7070
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9945207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083665Medicare ID - Type Unspecified
F74072Medicare UPIN