1356129670 NPI number — RUBI ALEJANDRA CASTILLO DELGADO

Table of content: RUBI ALEJANDRA CASTILLO DELGADO (NPI 1356129670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356129670 NPI number — RUBI ALEJANDRA CASTILLO DELGADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO DELGADO
Provider First Name:
RUBI
Provider Middle Name:
ALEJANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356129670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 NEBRASKA AVE BLDG A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97527-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-956-4943
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
348 RUBY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97404-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-461-3075
Provider Business Practice Location Address Fax Number:
541-461-1361
Provider Enumeration Date:
09/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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