Provider Demographics
NPI:1174549182
Name:CASTILLO-RUIZ, RODOLFO (MD)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:CASTILLO-RUIZ
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 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8023
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:160
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-269-1500
Practice Address - Fax:805-269-1585
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71031FMedicaid
CAHAP71031FOtherFAMILY PLANNING
CAW1508EMedicare PIN
CAWA51574FMedicare PIN
CA551983Medicare Oscar/Certification
CAHAP71031FOtherFAMILY PLANNING