Provider Demographics
NPI:1225135957
Name:CASTORENO, ROSEMARY (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:CASTORENO
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 1:4102 S NEW BRAUNFELS AVE STE 110-482
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1707
Mailing Address - Country:US
Mailing Address - Phone:210-333-0733
Mailing Address - Fax:210-333-0763
Practice Address - Street 1:1611 N ALAMO ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1211
Practice Address - Country:US
Practice Address - Phone:210-333-0733
Practice Address - Fax:210-333-0763
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138061207R00000X
CAC168306207R00000X
TXM3966207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183531602Medicaid
TX8G9391Medicare PIN
TX8L7757Medicare PIN
TXI66468Medicare UPIN