Healthcare Provider Details

I. General information

NPI: 1750674412
Provider Name (Legal Business Name): RUPERTO CASTANEDA VALLARTA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HIGHLAND AVE
LEWISTOWN PA
17044-1167
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 717-242-4254
  • Fax: 717-242-4234
Mailing address:
  • Phone: 717-242-4254
  • Fax: 717-242-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD494859
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: