Provider Demographics
NPI:1750303517
Name:CASTANEDA-ZUNIGA, WILFRIDO ROLANDO (MD)
Entity Type:Individual
Prefix:
First Name:WILFRIDO
Middle Name:ROLANDO
Last Name:CASTANEDA-ZUNIGA
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 1:6010 MCPHERSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6208
Mailing Address - Country:US
Mailing Address - Phone:956-727-2362
Mailing Address - Fax:956-727-2363
Practice Address - Street 1:6010 MCPHERSON RD STE 200
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6208
Practice Address - Country:US
Practice Address - Phone:956-727-2362
Practice Address - Fax:956-727-2363
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN238052085R0204X
TXN35422085R0202X, 2085R0204X
LA09542R2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1963593Medicaid
5R544Medicare ID - Type Unspecified
B58275Medicare UPIN