Healthcare Provider Details

I. General information

NPI: 1114477999
Provider Name (Legal Business Name): CASTELLANA PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO INTERNACIONAL DE MERCADEO TORRE II OFIC 505
GUAYNABO PR
00927
US

IV. Provider business mailing address

PO BOX 71500
SAN JUAN PR
00936-8600
US

V. Phone/Fax

Practice location:
  • Phone: 787-282-6990
  • Fax: 787-520-6060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL F MONTALVO
Title or Position: PRESIDENT
Credential: M.D
Phone: 787-622-3000