Provider Demographics
NPI:1255023537
Name:CASTANO PEREZ, YUNIOR ISIDRO
Entity type:Individual
Prefix:
First Name:YUNIOR
Middle Name:ISIDRO
Last Name:CASTANO PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4619
Mailing Address - Country:US
Mailing Address - Phone:949-687-6107
Mailing Address - Fax:
Practice Address - Street 1:440 UNION AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3142
Practice Address - Country:US
Practice Address - Phone:949-687-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman