Provider Demographics
NPI:1164466355
Name:PEREZCASTRO, CARLOS EDWIN (US NAVY S-IDC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:EDWIN
Last Name:PEREZCASTRO
Suffix:
Gender:M
Credentials:US NAVY S-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-1980T PAKEKE STREET
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792
Mailing Address - Country:US
Mailing Address - Phone:808-668-1175
Mailing Address - Fax:
Practice Address - Street 1:2ND BATALLION 3RD MARINES BATALLION AID STATION
Practice Address - Street 2:BOX 63012
Practice Address - City:MCBH KANEOHE BAY
Practice Address - State:HI
Practice Address - Zip Code:96863-3006
Practice Address - Country:US
Practice Address - Phone:808-257-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman