Provider Demographics
NPI:1376305441
Name:CASTILLEJA ADULT CLINIC PLLC
Entity Type:Organization
Organization Name:CASTILLEJA ADULT CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLEJA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:956-394-2502
Mailing Address - Street 1:PO BOX 451044
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0025
Mailing Address - Country:US
Mailing Address - Phone:956-394-2502
Mailing Address - Fax:956-290-8059
Practice Address - Street 1:201 W HILLSIDE RD STE 17
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3197
Practice Address - Country:US
Practice Address - Phone:956-394-2502
Practice Address - Fax:956-290-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty