Provider Demographics
NPI:1366507287
Name:GONZALEZ CASTRODAD, LUIS RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAUL
Last Name:GONZALEZ CASTRODAD
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0429
Mailing Address - Country:US
Mailing Address - Phone:787-505-6741
Mailing Address - Fax:
Practice Address - Street 1:HDEZ.CARRION ST. # E -34
Practice Address - Street 2:MANATI MEDICAL CENTER
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0429
Practice Address - Country:US
Practice Address - Phone:787-854-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC797770Medicare UPIN