Provider Demographics
NPI:1437135126
Name:CASTANUELA, MARTHA E (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:CASTANUELA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3527
Mailing Address - Country:US
Mailing Address - Phone:956-548-7400
Mailing Address - Fax:956-621-3689
Practice Address - Street 1:733 PALM BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6116
Practice Address - Country:US
Practice Address - Phone:956-548-8845
Practice Address - Fax:956-550-8968
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1108Medicare ID - Type Unspecified
TXP59963Medicare UPIN