Provider Demographics
NPI:1780646786
Name:CASTRO-RIVERA, SAMUEL GUILLERMO (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GUILLERMO
Last Name:CASTRO-RIVERA
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:AZUCENA BOX 26 OJO DE AGUA
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-962-4749
Mailing Address - Fax:
Practice Address - Street 1:34-1 CALLE 43
Practice Address - Street 2:URB.MIRAFLORES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-3815
Practice Address - Country:US
Practice Address - Phone:787-797-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16024208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice