Provider Demographics
NPI:1306922976
Name:VIVES CASTRO, LIDGIA R (MD)
Entity type:Individual
Prefix:DR
First Name:LIDGIA
Middle Name:R
Last Name:VIVES CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIDGIA
Other - Middle Name:R
Other - Last Name:VIVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:URB. J CAPARRA
Mailing Address - Street 2:CALLE 1 B21
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:939-260-6861
Mailing Address - Fax:
Practice Address - Street 1:ANTIGUO EDIFICIO JESUS T PINERO 80100 ESQUINA MOLINILLO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00986
Practice Address - Country:US
Practice Address - Phone:787-626-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS156642084N0400X
PR114252084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRPM412OtherMEDICARE
PR039304700Medicaid