Provider Demographics
NPI:1942721766
Name:RIVERA CASTRO, ANGEL RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:RICARDO
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 1:885 6TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-3250
Mailing Address - Country:US
Mailing Address - Phone:908-798-9125
Mailing Address - Fax:
Practice Address - Street 1:310 COUNTY ROAD 14
Practice Address - Street 2:
Practice Address - City:DEL NORTE
Practice Address - State:CO
Practice Address - Zip Code:81132-8719
Practice Address - Country:US
Practice Address - Phone:719-657-2510
Practice Address - Fax:719-657-2511
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-01
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CO64332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital