Provider Demographics
NPI:1184341778
Name:CASTANON, MATTHEW (CNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CASTANON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14805 ORSTEN ARTIS AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4670
Mailing Address - Country:US
Mailing Address - Phone:915-252-3381
Mailing Address - Fax:
Practice Address - Street 1:1850 COPPER LOOP
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-8139
Practice Address - Country:US
Practice Address - Phone:575-647-7643
Practice Address - Fax:575-647-7630
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily