Provider Demographics
NPI:1336662980
Name:CASTRERO, JEAN C
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:C
Last Name:CASTRERO
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 1:139 CALLE ZORZAL
Mailing Address - Street 2:URB. BRISAS DE CANOVANAS
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-241-3508
Mailing Address - Fax:
Practice Address - Street 1:G11 CALLE I
Practice Address - Street 2:NUEVA VIDA EL TUQUE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-241-3508
Practice Address - Fax:787-569-8522
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6105463OtherPRIVATE
PR8809OtherTEM-P