Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21387 | PR |
NPI | 1013578426 |
---|---|
Provider Name | Alexander Castro Acevedo |
First Address | Juncos, PR 00777-5939 |
Second Address | Juncos, PR 00777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 26/06/2019 |