Provider Demographics
NPI:1881382737
Name:CASTRO-VASQUEZ, CARLOS ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:CASTRO-VASQUEZ
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 1:37890 WESTWOOD CIRCLE APT 201
Mailing Address - Street 2:
Mailing Address - City:WEST LAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:947-254-5714
Mailing Address - Fax:734-655-8430
Practice Address - Street 1:TRINITY HEALTH LIVONIA HOSPITAL
Practice Address - Street 2:36475 FIVE MILE RD
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-655-2727
Practice Address - Fax:734-655-8430
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program