Provider Demographics
NPI:1831662972
Name:CASTILLO, GERARDO (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PMHNP-BC
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 537
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1609
Mailing Address - Country:US
Mailing Address - Phone:956-627-4874
Mailing Address - Fax:
Practice Address - Street 1:909 E ESPERANZA AVE STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1453
Practice Address - Country:US
Practice Address - Phone:956-627-4874
Practice Address - Fax:956-329-2931
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4360760-01Medicaid
TXP02637391OtherINDIVIDUAL RR MEDICARE
TX8QV236OtherSOLO BCBS
TX1X3322OtherINDIVIDUAL MEDICARE