Provider Demographics
NPI:1023198454
Name:CASTILLO, LETICIA (MD)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:217-648-2228
Mailing Address - Fax:214-648-2253
Practice Address - Street 1:5353 HARRY HINES BLVD
Practice Address - Street 2:MC9063
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-648-2228
Practice Address - Fax:214-648-2253
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414322080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175498801Medicaid
TX175498801Medicaid
D87805Medicare UPIN