Provider Demographics
NPI:1114251345
Name:CASTRO-VELEZ, CARMEN LYDIA (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LYDIA
Last Name:CASTRO-VELEZ
Suffix:
Gender:F
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:PO BOX 141494
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-817-3643
Mailing Address - Fax:787-817-3643
Practice Address - Street 1:CARR. 651 K.M. 1.7
Practice Address - Street 2:BO. HATO ARRIBA, SECTOR JUNCOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-3643
Practice Address - Fax:787-817-3643
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17758208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCT492AOtherMEDICARE PTAN