Provider Demographics
NPI:1750554093
Name:CASTILLO, JUANITA
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8416 OLD MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6499
Mailing Address - Country:US
Mailing Address - Phone:254-307-3997
Mailing Address - Fax:254-300-9935
Practice Address - Street 1:8416 OLD MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6499
Practice Address - Country:US
Practice Address - Phone:254-307-3997
Practice Address - Fax:254-300-9935
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP2836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program