Provider Demographics
NPI:1205318318
Name:CASTILLO, ENRIQUE JR
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CASTILLO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E MYRTLE BEACH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1940
Mailing Address - Country:US
Mailing Address - Phone:956-223-7945
Mailing Address - Fax:
Practice Address - Street 1:912 E NOLANA LOOP
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5838
Practice Address - Country:US
Practice Address - Phone:956-502-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant