Provider Demographics
NPI:1558323717
Name:WOMEN'S WELLNESS & HEALTHCARE CLINIC
Entity Type:Organization
Organization Name:WOMEN'S WELLNESS & HEALTHCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-753-7600
Mailing Address - Street 1:1710 E. SAUNDERS
Mailing Address - Street 2:SUITE A200
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2213
Mailing Address - Country:US
Mailing Address - Phone:956-753-7600
Mailing Address - Fax:956-753-7800
Practice Address - Street 1:1710 E. SAUNDERS
Practice Address - Street 2:SUITE A200
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2213
Practice Address - Country:US
Practice Address - Phone:956-753-7600
Practice Address - Fax:956-753-7800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMEN'S WELLNESS & HEALTHCARE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-04
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9748174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030EROtherBLUE CROSS BLUE SHIELD
TX0796211-01Medicaid
TXH26576Medicare UPIN