Provider Demographics
NPI:1679587893
Name:CASTRO, LUIS JERONIMO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JERONIMO
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2915
Mailing Address - Fax:
Practice Address - Street 1:2900 WHIPPLE AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2851
Practice Address - Country:US
Practice Address - Phone:650-261-2366
Practice Address - Fax:650-261-2369
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72322204F00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G723220Medicaid
CAGR0052800Medicaid
CACP2153OtherRAILROAD MEDICARE
CA00G72323Medicare PIN
CAZZZ05047ZMedicare PIN
CAAP493Medicare PIN
CABF304Medicare PIN
CAZZZ23469ZMedicare PIN
CA00G723220Medicaid
CAZZZ02406ZMedicare PIN
CA00G723221Medicare PIN
CAGR0052800Medicaid