Provider Demographics
NPI:1881230225
Name:CASTANON, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:CASTANON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 LARRY RD
Mailing Address - Street 2:
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835-8424
Mailing Address - Country:US
Mailing Address - Phone:915-979-6488
Mailing Address - Fax:
Practice Address - Street 1:1218 LARRY RD
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-8424
Practice Address - Country:US
Practice Address - Phone:915-979-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351350164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse