Provider Demographics
NPI:1225590060
Name:ALICEA CASTRO, ERIC GABRIEL (MEDICAL STUDENT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:GABRIEL
Last Name:ALICEA CASTRO
Suffix:
Gender:M
Credentials:MEDICAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS DE LA PLAYA #714
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00693
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DE LA PLAYA #714
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00693
Practice Address - Country:UM
Practice Address - Phone:787-249-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program