Provider Demographics
NPI:1740607050
Name:DECASTRO, VINCENZ LIM (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENZ
Middle Name:LIM
Last Name:DECASTRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6210 E US HWY 290
Mailing Address - Street 2:SUITE 420-CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1098
Mailing Address - Country:US
Mailing Address - Phone:512-338-3826
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:3420 FM 967 STE B100
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3113
Practice Address - Country:US
Practice Address - Phone:512-295-1608
Practice Address - Fax:512-406-7325
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367810402Medicaid
TX367810401Medicaid
TX367810402Medicaid
TX367810401Medicaid