Provider Demographics
NPI:1073562484
Name:CASTRO-ARREOLA, MANUEL E (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:E
Last Name:CASTRO-ARREOLA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 W. WHEATLAND ROAD
Mailing Address - Street 2:POB I SUITE 119
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237
Mailing Address - Country:US
Mailing Address - Phone:972-709-7110
Mailing Address - Fax:972-709-7128
Practice Address - Street 1:3430 W. WHEATLAND ROAD
Practice Address - Street 2:BLDG I SUITE 119
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:972-709-7110
Practice Address - Fax:972-709-7128
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6897208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1341620-09Medicaid
8X6740OtherBC/BS
TX8X6740OtherBCBS
TX1341620-08Medicaid
8F5263OtherMEDICARE PTAN
F41974Medicare UPIN
8F5263OtherMEDICARE PTAN