Provider Demographics
NPI:1316543044
Name:CASTRO SALDARRIAGA, JOHN MARIO
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARIO
Last Name:CASTRO SALDARRIAGA
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 1:3238 ZEPHYR GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7094
Mailing Address - Country:US
Mailing Address - Phone:832-973-1644
Mailing Address - Fax:
Practice Address - Street 1:2026 WIRT RD STE 103B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1626
Practice Address - Country:US
Practice Address - Phone:832-980-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist