Provider Demographics
NPI:1144236480
Name:CASTRO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:CASTRO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-794-0704
Mailing Address - Street 1:23 ST YY-6
Mailing Address - Street 2:URS SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-794-0704
Mailing Address - Fax:787-794-0704
Practice Address - Street 1:LUIS MUNOZ RIVERA 10
Practice Address - Street 2:PUEBLO
Practice Address - City:TAO BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-794-0704
Practice Address - Fax:787-794-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5375570001Medicare ID - Type Unspecified