Provider Demographics
NPI:1881656429
Name:CASTILLON, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:CASTILLON
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 1:1710 E. SAUNDERS
Mailing Address - Street 2:SUITE A200
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2213
Mailing Address - Country:US
Mailing Address - Phone:956-753-7600
Mailing Address - Fax:956-753-7800
Practice Address - Street 1:1710 E. SAUNDERS
Practice Address - Street 2:SUITE A200
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2213
Practice Address - Country:US
Practice Address - Phone:956-753-7600
Practice Address - Fax:956-753-7800
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9748207VX0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0392755-01Medicaid
TX8A2268OtherBLUE CROSS BLUE SHIELD
TX8A2268OtherBLUE CROSS BLUE SHIELD