Provider Demographics
NPI:1720162092
Name:CASTRO-RUEDA, HERNAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:HERNAN
Middle Name:P
Last Name:CASTRO-RUEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1671
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-7246
Practice Address - Fax:949-364-1647
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036116360207RR0500X
CAA96092207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
754210002Medicare PIN
CADT094YMedicare PIN
CADT094ZMedicare PIN
0533210001Medicare NSC