Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 9148 | TX |
NPI | 1659466621 |
---|---|
Provider Name | Dr. Martin Castillo JR. |
First Address | Pharr, TX 78577-5358 |
Second Address | Pharr, TX 78577-5358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 25/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8F20525 | MEDICARE PTAN (01) | TX |