Healthcare Provider Details

I. General information

NPI: 1285622787
Provider Name (Legal Business Name): SIGIFREDO MININO-CASTILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO HOSPITAL SAN LUCAS DEPT TERAPIA FISICA
PONCE PR
00716-4728
US

IV. Provider business mailing address

35260 CALLE CLAVELLINA URB JACARANDA
PONCE PR
00730-1689
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-1110
  • Fax: 787-844-7288
Mailing address:
  • Phone: 787-844-1110
  • Fax: 787-844-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number3755
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: