Healthcare Provider Details

I. General information

NPI: 1063412856
Provider Name (Legal Business Name): RUBEN DARIO ROSARIO CASTILLO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/25/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 116 KM 2.0 BO SABANA YEGUAS
LAJAS PR
00667-2061
US

IV. Provider business mailing address

PO BOX 902
LAJAS PR
00667-0902
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-2865
  • Fax: 787-899-2865
Mailing address:
  • Phone: 787-899-2865
  • Fax: 787-899-2865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14435
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: