Provider Demographics
NPI:1770628570
Name:ROBERT MANUEL CASTILLO
Entity Type:Organization
Organization Name:ROBERT MANUEL CASTILLO
Other - Org Name:CENTER STREET MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-788-8135
Mailing Address - Street 1:PO BOX 70109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77270-0109
Mailing Address - Country:US
Mailing Address - Phone:713-869-4631
Mailing Address - Fax:713-869-8148
Practice Address - Street 1:4302 CENTER STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5616
Practice Address - Country:US
Practice Address - Phone:713-869-4631
Practice Address - Fax:713-869-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1817208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162706902Medicaid
TX162706901Medicaid
00937VMedicare PIN
TXC14301Medicare UPIN