Provider Demographics
NPI:1609875335
Name:CASTRO DIAZ, JOSE JULIAN
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JULIAN
Last Name:CASTRO DIAZ
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:PO BOX 2056
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2056
Mailing Address - Country:US
Mailing Address - Phone:787-735-7500
Mailing Address - Fax:787-735-7500
Practice Address - Street 1:EDIFICION PROFESSIONAL, 301 HOSPITAL MEMOMITA
Practice Address - Street 2:CALLE JOSE SABASTIAN
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-2056
Practice Address - Country:US
Practice Address - Phone:787-735-7500
Practice Address - Fax:787-735-7500
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7067174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-8451CAOtherSSS
PRM00324OtherPLAN DE SALUD MENONITA
PR6090035Medicaid
PR601254OtherMEDICARE Y MUCHO MAS
PRC-70529Medicare UPIN
PRM00324OtherPLAN DE SALUD MENONITA