Provider Demographics
NPI:1881733640
Name:CASTRO MALDONADO, CARLOS A (OD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:CASTRO MALDONADO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 EVIS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414
Mailing Address - Country:US
Mailing Address - Phone:787-380-6715
Mailing Address - Fax:
Practice Address - Street 1:4802 SPID DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4202
Practice Address - Country:US
Practice Address - Phone:361-992-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100030OtherLA CRUZ AZUL
PR660614288OtherCOSVI
PR890162OtherMEDICARE Y MUCHO MAS
PR7140015OtherHUMANA HEALTH PLANS
PR50662OtherPMC
PR660614288OtherCOSVI
PR62541Medicare ID - Type Unspecified