Provider Demographics
NPI:1922230481
Name:CASTILLO, LUIS (RN BS)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:RN BS
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 1121
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-1121
Mailing Address - Country:US
Mailing Address - Phone:361-562-1762
Mailing Address - Fax:
Practice Address - Street 1:130 COUNTY ROAD 134
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78333-1121
Practice Address - Country:US
Practice Address - Phone:361-562-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX593987163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse