Provider Demographics
NPI:1285622787
Name:MININO-CASTILLO, SIGIFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:SIGIFREDO
Middle Name:
Last Name:MININO-CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35260 CALLE CLAVELLINA
Mailing Address - Street 2:URB JACARANDA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1689
Mailing Address - Country:US
Mailing Address - Phone:787-844-1110
Mailing Address - Fax:787-844-7288
Practice Address - Street 1:909 AVE TITO CASTRO
Practice Address - Street 2:HOSPITAL SAN LUCAS DEPT TERAPIA FISICA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-844-1110
Practice Address - Fax:787-844-7288
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3755208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR94905 MIMedicare ID - Type UnspecifiedPHYSIATRIST
PRE31135Medicare UPIN
0094905Medicare PIN