Provider Demographics
NPI:1972773992
Name:CASTRO, ALBA S (MT)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:S
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CELESTIAL 2392A LOS ANGELES
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1655
Mailing Address - Country:US
Mailing Address - Phone:787-791-1318
Mailing Address - Fax:
Practice Address - Street 1:CALLE CELESTIAL 2392A LOS ANGELES
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-1655
Practice Address - Country:US
Practice Address - Phone:787-791-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2518246QM0706X
PR887291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31125Medicare PIN