Provider Demographics
NPI:1679968580
Name:RONQUILLO, CECINIO CASTILLO JR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CECINIO
Middle Name:CASTILLO
Last Name:RONQUILLO
Suffix:JR
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:ROOM 4C104
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-581-7606
Mailing Address - Fax:
Practice Address - Street 1:2770 N UNION BLVD STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1183
Practice Address - Country:US
Practice Address - Phone:719-473-9595
Practice Address - Fax:719-227-0669
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0065385207WX0107X
UT10104226-1205207W00000X
UT10104226-8905207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000195721Medicaid