Provider Demographics
NPI:1356524490
Name:GREGORIO JOEL CASTILLO, M.D. P.A.
Entity type:Organization
Organization Name:GREGORIO JOEL CASTILLO, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORIO JOEL
Authorized Official - Middle Name:ASUNCION
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-592-8880
Mailing Address - Street 1:10501 VISTA DEL SOL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7940
Mailing Address - Country:US
Mailing Address - Phone:915-592-8880
Mailing Address - Fax:915-592-8883
Practice Address - Street 1:10501 VISTA DEL SOL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7940
Practice Address - Country:US
Practice Address - Phone:915-592-8880
Practice Address - Fax:915-592-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8950261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1684649-01Medicaid
TX00267XMedicare PIN
TXG10718Medicare UPIN