Dr Ruperto Castaneda Vallarta Jr, MD | |
211 Nw Larch Ave, Redmond, OR 97756-1357 | |
(541) 548-2164 | |
(541) 548-0534 |
Full Name | Dr Ruperto Castaneda Vallarta Jr |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 211 Nw Larch Ave, Redmond, Oregon |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1750674412 | NPI | - | NPPES |
003642900 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | MD166206 (Oregon) | Primary |
Entity Name | Privia Medical Group Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1013042480 PECOS PAC ID: 4385682061 Enrollment ID: O20050422000298 |
Entity Name | Privia Care Center Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1164874426 PECOS PAC ID: 3274801139 Enrollment ID: O20170616001775 |
Mailing Address | Practice Location Address |
---|---|
Dr Ruperto Castaneda Vallarta Jr, MD Po Box 5579, Bend, OR 97708-5579 Ph: (541) 548-2164 | Dr Ruperto Castaneda Vallarta Jr, MD 211 Nw Larch Ave, Redmond, OR 97756-1357 Ph: (541) 548-2164 |
Margaret J Philp, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 211 Nw Larch Ave, Redmond, OR 97756 Phone: 541-548-2164 Fax: 541-548-0534 | |
Nancy Dayzie Heavilin, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 211 Nw Larch Ave, Redmond, OR 97756 Phone: 541-548-2164 Fax: 541-548-0534 | |
Thomas N Ernst, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 211 Nw Larch Ave, Redmond, OR 97756 Phone: 541-548-2164 Fax: 541-548-0534 |