Provider Demographics
NPI:1740786664
Name:LOPEZ CASTELLANOS, JOSE RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RICARDO
Last Name:LOPEZ CASTELLANOS
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 1:101 E CORRY ST UNIT 323
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2588
Mailing Address - Country:US
Mailing Address - Phone:832-857-1427
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 500
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-296-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program