Provider Demographics
NPI:1740287440
Name:CASTILLO, RICARDO (DO)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19114 US HIGHWAY 281 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4988
Mailing Address - Country:US
Mailing Address - Phone:210-496-7999
Mailing Address - Fax:210-494-1666
Practice Address - Street 1:19114 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4988
Practice Address - Country:US
Practice Address - Phone:210-496-7999
Practice Address - Fax:210-494-1666
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1390403-08OtherWELLMED MEDICAID
TX81092GOtherWELLMED MEDICARE
TX1390403-08OtherWELLMED MEDICAID