Provider Demographics
NPI:1922044650
Name:CASTA-MENDEZ, IDA M (MD)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:M
Last Name:CASTA-MENDEZ
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:PO BOX 4164
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:787-819-1305
Mailing Address - Fax:787-819-1305
Practice Address - Street 1:AVE ALBIZU CAMPOS #156 REPARTO LOPEZ
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-819-1305
Practice Address - Fax:787-819-1305
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3068208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8000286OtherHUMANA
1416OtherPREFERRED MEDICARE CHOICE
PR0023350Medicare ID - Type Unspecified
1416OtherPREFERRED MEDICARE CHOICE