Provider Demographics
NPI:1629475991
Name:CASTILLO ALICEA, CESAR A
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:A
Last Name:CASTILLO ALICEA
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 363161
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3161
Mailing Address - Country:US
Mailing Address - Phone:787-486-0925
Mailing Address - Fax:
Practice Address - Street 1:1789 CARR 21 STE 315
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3339
Practice Address - Country:US
Practice Address - Phone:787-486-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21624208600000X, 2086S0129X
PR13920-I208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program