Provider Demographics
NPI:1568531531
Name:CASTRO, XIOMARY Z
Entity Type:Individual
Prefix:
First Name:XIOMARY
Middle Name:Z
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
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 1046
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1046
Mailing Address - Country:US
Mailing Address - Phone:787-896-2222
Mailing Address - Fax:787-896-2222
Practice Address - Street 1:CARR 109 KM 27.8
Practice Address - Street 2:BO CULEBRINAS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-9998
Practice Address - Country:US
Practice Address - Phone:787-896-2222
Practice Address - Fax:787-896-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1332133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist