Provider Demographics
NPI:1720729403
Name:CASTILLO, MARTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 KERLEY DR
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4368
Mailing Address - Country:US
Mailing Address - Phone:512-913-3073
Mailing Address - Fax:
Practice Address - Street 1:13617 CALDWELL DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2324
Practice Address - Country:US
Practice Address - Phone:512-846-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA16218OtherPROFESSIONAL LICENSE NUMBER