Provider Demographics
NPI:1346713534
Name:CASTRO, MARIA DOLORES
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STEWART
Mailing Address - Street 2:
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014
Mailing Address - Country:US
Mailing Address - Phone:830-879-2502
Mailing Address - Fax:
Practice Address - Street 1:105 STEWART
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014
Practice Address - Country:US
Practice Address - Phone:830-879-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program