Provider Demographics
NPI:1972542678
Name:CASTILLO, ROGELIO (PAC)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002W SAM HOUSTON BLVD 4
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5198
Mailing Address - Country:US
Mailing Address - Phone:956-783-1400
Mailing Address - Fax:956-783-8818
Practice Address - Street 1:807 N. CAGE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-283-1889
Practice Address - Fax:956-283-7014
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02343363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02343OtherTEXAS STATE MEDICAL LIC.