Provider Demographics
NPI:1538546817
Name:CASTILLA-PUENTES, RUBY (MD, DRPH, MBA)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:CASTILLA-PUENTES
Suffix:
Gender:F
Credentials:MD, DRPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SOUTH 2ND ST
Mailing Address - Street 2:SUITE 743
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147
Mailing Address - Country:US
Mailing Address - Phone:215-546-1432
Mailing Address - Fax:
Practice Address - Street 1:530 S 2ND ST
Practice Address - Street 2:SUITE 743
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2420
Practice Address - Country:US
Practice Address - Phone:215-546-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAME#264098900402084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
26409890040OtherME#