Provider Demographics
NPI:1316044704
Name:CASTRO RODRIGUEZ, JOSE MANUEL (MD, FACR)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:CASTRO RODRIGUEZ
Suffix:
Gender:M
Credentials:MD, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARBELLA 22
Mailing Address - Street 2:URB PASEO LAS BRISAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-755-2551
Mailing Address - Fax:787-767-4119
Practice Address - Street 1:TORRE SAN FRANCISCO
Practice Address - Street 2:SUITE 408, AVE DE DIEGO 369
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-767-4100
Practice Address - Fax:787-767-4119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4176261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-83950Medicare UPIN
PR95174Medicare ID - Type Unspecified