Provider Demographics
NPI:1154814010
Name:LATORRE CASTRO, LUIS OTTONIEL
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:OTTONIEL
Last Name:LATORRE CASTRO
Suffix:
Gender:M
Credentials:
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 191811 SAN JUAN PR 00919-1811
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935-0001
Mailing Address - Country:US
Mailing Address - Phone:787-763-4149
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO RIO PIEDRAS
Practice Address - Street 2:HOSPITAL ONCOLOGICO DR I GONZALEZ MARTINEZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22030208D00000X
PR14742I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty