Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | G72322 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G72322 | CA |
NPI | 1679587893 |
---|---|
Provider Name | Dr. Luis Jeronimo Castro |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Redwood City, CA 94062-2851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 31/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G723220 | (05) | CA |
CP2153 | RAILROAD MEDICARE (01) | CA |
G66611 | (02) | CA |
GR0052800 | (05) | CA |