Provider Demographics
NPI:1922060540
Name:CASTRO, VICENTE LOMBARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:LOMBARDO
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 1:1777 S ANDREWS AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2517
Mailing Address - Country:US
Mailing Address - Phone:954-763-8355
Mailing Address - Fax:954-764-0642
Practice Address - Street 1:1777 S ANDREWS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2517
Practice Address - Country:US
Practice Address - Phone:954-763-8355
Practice Address - Fax:954-764-0642
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00025365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93208OtherBCBS
FLD27717Medicare UPIN
FL93208OtherBCBS