Provider Demographics
NPI:1639442353
Name:CASTILLO, JESUS I (RPSGT)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:I
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:TX
Mailing Address - Zip Code:76527-4048
Mailing Address - Country:US
Mailing Address - Phone:254-291-6085
Mailing Address - Fax:
Practice Address - Street 1:3401 KAYDENCE CT
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3356
Practice Address - Country:US
Practice Address - Phone:254-200-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1352542471V0105X
KS1344-5635247200000X
VA13841246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other