Provider Demographics
NPI:1598027583
Name:CASTRO SOTO, ANDRES F
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:F
Last Name:CASTRO SOTO
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 1:158 CALLE CEDRO
Mailing Address - Street 2:LOS ROBLES
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4213
Mailing Address - Country:US
Mailing Address - Phone:787-224-4425
Mailing Address - Fax:
Practice Address - Street 1:158 CALLE CEDRO
Practice Address - Street 2:LOS ROBLES
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4213
Practice Address - Country:US
Practice Address - Phone:787-224-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR751156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician