Provider Demographics
NPI:1174736060
Name:GONZALEZ-CASTRODAD, CARLOS MANUEL
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:GONZALEZ-CASTRODAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 CALLE SAN DIEGO
Mailing Address - Street 2:SAN IGNACIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6805
Mailing Address - Country:US
Mailing Address - Phone:787-525-2730
Mailing Address - Fax:
Practice Address - Street 1:653 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-3203
Practice Address - Country:US
Practice Address - Phone:787-722-3600
Practice Address - Fax:787-722-6555
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002255183500000X
FLPS37419183500000X
GARPH015546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist