Provider Demographics
NPI:1912005521
Name:CASTRO, IRIS R
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:R
Last Name:CASTRO
Suffix:
Gender:F
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 1916
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-1916
Mailing Address - Country:US
Mailing Address - Phone:787-876-3967
Mailing Address - Fax:787-876-3967
Practice Address - Street 1:STREET 185 KM 4.5 BO. CAMPO RICO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9727
Practice Address - Country:US
Practice Address - Phone:787-876-3967
Practice Address - Fax:787-876-3967
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057620Medicare PIN