Provider Demographics
NPI:1225274335
Name:CASTILLO, RICHARD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROBERT
Last Name: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 1:3000 ESPANOLA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2731
Mailing Address - Country:US
Mailing Address - Phone:505-884-5274
Mailing Address - Fax:505-884-5274
Practice Address - Street 1:3000 ESPANOLA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2731
Practice Address - Country:US
Practice Address - Phone:505-884-5274
Practice Address - Fax:505-884-5274
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56-53208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice