Provider Demographics
NPI:1144616525
Name:CASTRO, CARLOS FERNAN III (RN)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:FERNAN
Last Name:CASTRO
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 DENMAN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2269
Mailing Address - Country:US
Mailing Address - Phone:347-549-3775
Mailing Address - Fax:
Practice Address - Street 1:4157 DENMAN ST FL 3
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2269
Practice Address - Country:US
Practice Address - Phone:347-549-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656862-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse