Provider Demographics
NPI:1376646703
Name:CASTRO, CARLOS (CRNA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:CRNA
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 7238
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-0938
Mailing Address - Country:US
Mailing Address - Phone:201-566-3991
Mailing Address - Fax:
Practice Address - Street 1:414 76TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5504
Practice Address - Country:US
Practice Address - Phone:201-566-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10265700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083421CDZMedicare PIN
NJ083421A01Medicare PIN
NJ083421CDYMedicare PIN