Healthcare Provider Details

I. General information

NPI: 1962965293
Provider Name (Legal Business Name): RUBEN ANTONIO CASTRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DRIVE SOUTH
ORANGE CA
92868
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 650
ORANGE CA
92868-3224
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5253
  • Fax:
Mailing address:
  • Phone: 714-456-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA180838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: