Provider Demographics
NPI:1770367344
Name:CASTILLO, LAURA ELENA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELENA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 THUNDERBIRD DR STE K
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4563
Mailing Address - Country:US
Mailing Address - Phone:915-229-1004
Mailing Address - Fax:915-277-4487
Practice Address - Street 1:125 THUNDERBIRD DR STE K
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4563
Practice Address - Country:US
Practice Address - Phone:915-229-1004
Practice Address - Fax:915-277-4487
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX706382085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty