Healthcare Provider Details

I. General information

NPI: 1174432751
Provider Name (Legal Business Name): RUBEN OMAR CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

PSC 80 BOX 12498
APO AP
96367-0027
US

V. Phone/Fax

Practice location:
  • Phone: 315-646-7488
  • Fax:
Mailing address:
  • Phone: 210-343-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number95061197
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number889065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: