Provider Demographics
NPI:1275312852
Name:CASTILLO MARTINEZ, JESUS EDUARDO
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:EDUARDO
Last Name:CASTILLO MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 OTTUMWA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6358
Mailing Address - Country:US
Mailing Address - Phone:956-258-8302
Mailing Address - Fax:
Practice Address - Street 1:1102 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9105
Practice Address - Country:US
Practice Address - Phone:956-388-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136455363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care