Provider Demographics
NPI:1588609507
Name:CASTRO-REYES, WILFRED (MD)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:CASTRO-REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11777 FM 1960 W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065
Mailing Address - Country:US
Mailing Address - Phone:210-832-1750
Mailing Address - Fax:832-825-1717
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2608
Practice Address - Country:US
Practice Address - Phone:832-828-3660
Practice Address - Fax:832-828-3660
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG21142084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126357602Medicaid
104301OtherSUPERIOR CHIPS
TX126357603OtherCSHCN
E77143Medicare UPIN
TX00G59MMedicare ID - Type Unspecified