Provider Demographics
NPI:1215171806
Name:CASTRO, EIDA MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:EIDA
Middle Name:MARIA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 AVE LAS AMERICAS
Mailing Address - Street 2:PORRATA PILA EDIFICIO A SUIT 205
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2113
Mailing Address - Country:US
Mailing Address - Phone:787-848-5050
Mailing Address - Fax:787-848-5175
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:PORRATA PILA EDIFICIO A SUIT 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-848-5050
Practice Address - Fax:787-848-5175
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical