Provider Demographics
NPI:1104846468
Name:CASTRO, OSVALDO (MD)
Entity Type:Individual
Prefix:
First Name:OSVALDO
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 1:51 CALLE ANDRES GARCIA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4350
Mailing Address - Country:US
Mailing Address - Phone:787-617-5951
Mailing Address - Fax:787-879-4691
Practice Address - Street 1:51 CALLE ANDRES GARCIA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4350
Practice Address - Country:US
Practice Address - Phone:787-650-3522
Practice Address - Fax:787-879-4691
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16283208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23862 CAOtherTRIPLE S
PRDM286AMedicare UPIN