Healthcare Provider Details

I. General information

NPI: 1750015764
Provider Name (Legal Business Name): KVRISMAR GONZALEZ CASTILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EXT FOREST HILLS VALENCIA ST 842
BAYAMON PR
00959
US

IV. Provider business mailing address

EXT FOREST HILLS VALENCIA ST 842
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-552-6503
  • Fax:
Mailing address:
  • Phone: 787-552-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number24313
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24313
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: