Provider Demographics
NPI:1225166960
Name:CASTILLERO, ROBERTO (MED)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:CASTILLERO
Suffix:
Gender:M
Credentials:MED
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 396
Mailing Address - Street 2:
Mailing Address - City:LYFORD
Mailing Address - State:TX
Mailing Address - Zip Code:78569-0396
Mailing Address - Country:US
Mailing Address - Phone:956-966-4506
Mailing Address - Fax:
Practice Address - Street 1:378 WEST GLEN LOFTON ST
Practice Address - Street 2:
Practice Address - City:LYFORD
Practice Address - State:TX
Practice Address - Zip Code:78569-0396
Practice Address - Country:US
Practice Address - Phone:956-966-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12221103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool