Provider Demographics
NPI:1255757779
Name:DEL CASTILLO, DAVID OMAR
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:OMAR
Last Name:DEL CASTILLO
Suffix:
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 1:2811 LA FRONTERA BLVD APT 2611
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-1197
Mailing Address - Country:US
Mailing Address - Phone:512-763-7704
Mailing Address - Fax:
Practice Address - Street 1:2811 LA FRONTERA BLVD APT 2611
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-1197
Practice Address - Country:US
Practice Address - Phone:512-763-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1862056171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor