Provider Demographics
NPI:1174760946
Name:DE CASTRO, MARIA TRINIDAD LIRAG
Entity type:Individual
Prefix:MRS
First Name:MARIA TRINIDAD
Middle Name:LIRAG
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 STRONG PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2620
Mailing Address - Country:US
Mailing Address - Phone:908-755-6569
Mailing Address - Fax:
Practice Address - Street 1:118 STRONG PL
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2620
Practice Address - Country:US
Practice Address - Phone:908-755-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01098300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist