Provider Demographics
NPI:1629336094
Name:CASTRO, CARLA VANESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:VANESSA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:VANESSA
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:37 BELLA VISTA GDNS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-8316
Mailing Address - Country:US
Mailing Address - Phone:925-234-4388
Mailing Address - Fax:925-234-4388
Practice Address - Street 1:37 BELLA VISTA GDNS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-8316
Practice Address - Country:US
Practice Address - Phone:925-234-4388
Practice Address - Fax:925-234-4388
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18414208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice