Provider Demographics
NPI:1093702987
Name:CASTREJON, EDUARDO A (MD PA)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:A
Last Name:CASTREJON
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3755
Mailing Address - Country:US
Mailing Address - Phone:505-524-9119
Mailing Address - Fax:505-525-1889
Practice Address - Street 1:1205 S SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3755
Practice Address - Country:US
Practice Address - Phone:505-254-9119
Practice Address - Fax:505-525-1889
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM82-19207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201001583Medicaid
NM85-0440261Medicaid
NM188063500OtherRAIL ROAD MEDICARE
NM0505OtherBCBS
NM08656Medicaid
TX073952601OtherTEXAS MEDICAID
TX073952601OtherTEXAS MEDICAID
NM0505OtherBCBS