MEDICARE: REUBEN C CASTILLO, PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A056105	CA

General Provider Information

NPI Number	:	1942429188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REUBEN C CASTILLO, PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 280
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92572-0280
Country	:	US
Telephone Number	:	951-657-5441
Fax Number	:	951-943-4938

Provider Business Practice Location Address
First Line	:	498 W 4TH ST
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92570-2070
Country	:	US
Telephone Number	:	951-654-5441
Fax Number	:	951-943-4938

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. REUBEN CARLOS CASTILLO
Credential	:	M.D.
Telephone Number	:	951-657-5441

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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