Provider Demographics
NPI:1407083256
Name:DE CASTRO PRETELT, MAURICIO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:JOSE
Last Name:DE CASTRO PRETELT
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 1:541 N CORNICHE DU LAC
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7260
Mailing Address - Country:US
Mailing Address - Phone:813-253-9291
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE STE 5D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-4211
Practice Address - Fax:405-271-2263
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250567207SG0203X, 207SG0201X
OK46520207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics