Provider Demographics
NPI:1275756140
Name:CASTILLO, MARTHA ALICE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALICE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 BETHLEHEM ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1917
Mailing Address - Country:US
Mailing Address - Phone:713-472-5679
Mailing Address - Fax:
Practice Address - Street 1:1251 BETHLEHEM ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1917
Practice Address - Country:US
Practice Address - Phone:713-472-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX742171363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care