Provider Demographics
NPI:1336153980
Name:RIVERA - CASTRO, ANGEL (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:RIVERA - CASTRO
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 1:283 CAMINO DEL MANGO
Mailing Address - Street 2:SABANERA DEL RIO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-744-3017
Mailing Address - Fax:787-276-0065
Practice Address - Street 1:11310 AVE. 65 INFANTERIA
Practice Address - Street 2:CARR 3 KM 12.3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-2477
Practice Address - Fax:787-276-0065
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11864207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83501 GMedicare ID - Type Unspecified
PRG40934Medicare UPIN