Provider Demographics
NPI:1770690406
Name:CASTRO AVILA, ROSA TAINA (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:TAINA
Last Name:CASTRO AVILA
Suffix:
Gender:F
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:COND EL MILENIO 200 CALLE 220
Mailing Address - Street 2:APT 701
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-2807
Mailing Address - Country:US
Mailing Address - Phone:787-632-6317
Mailing Address - Fax:
Practice Address - Street 1:220 AVE. CONDOMINIO EL MILENIO
Practice Address - Street 2:200 APT 701
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2807
Practice Address - Country:US
Practice Address - Phone:787-632-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14337208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021522Medicare ID - Type Unspecified
PRH84375Medicare UPIN