Healthcare Provider Details

I. General information

NPI: 1538114996
Provider Name (Legal Business Name): JOSUE CASTILLO ROBLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. EDUARDO RUBERTE #15
PONCE PR
00728
US

IV. Provider business mailing address

JARDINES DEL CARIBE CALLE11 # 101
PONCE PR
00728-4405
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-8812
  • Fax: 787-259-8812
Mailing address:
  • Phone: 787-259-8812
  • Fax: 787-259-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY LOU CASTILLO
Title or Position: ADMINISTRATIVE
Credential:
Phone: 787-259-8812