Provider Demographics
NPI:1235149501
Name:CASTRUITA, JESUS JOSE JR (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:JOSE
Last Name:CASTRUITA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901681
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44190-0001
Mailing Address - Country:US
Mailing Address - Phone:440-233-8181
Mailing Address - Fax:440-233-8182
Practice Address - Street 1:6125 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3820
Practice Address - Country:US
Practice Address - Phone:440-233-8181
Practice Address - Fax:440-233-8182
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17012207L00000X
OH35.073895207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1235149501OtherNPI
OH2082115Medicaid
OH1235149501OtherNPI