Provider Demographics
NPI:1790763373
Name:CASTRO, JOSE D (CSTCFA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:D
Last Name:CASTRO
Suffix:
Gender:M
Credentials:CSTCFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3744
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 E NOLANA ST
Practice Address - Street 2:SUITE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6114
Practice Address - Country:US
Practice Address - Phone:956-682-4152
Practice Address - Fax:956-682-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF01198246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025JROtherBCBS
TXOTH000Medicare UPIN