Provider Demographics
NPI:1184652869
Name:SOSTRE CASTILLO, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SOSTRE CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CALLE SORBONA
Mailing Address - Street 2:UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4012
Mailing Address - Country:US
Mailing Address - Phone:787-781-1477
Mailing Address - Fax:787-793-2881
Practice Address - Street 1:T-31 CARR 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3312
Practice Address - Country:US
Practice Address - Phone:787-781-1477
Practice Address - Fax:787-793-2881
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20700000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE15322Medicare UPIN
PR96831Medicare ID - Type Unspecified