Provider Demographics
NPI:1932197746
Name:CASTILLEJA, PATRICIA A (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CASTILLEJA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:
Practice Address - Street 1:2201 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-7523
Practice Address - Fax:254-200-4090
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558455367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88490UOtherBLUE CROSS BLUE SHIELD
TX100785100OtherFIRSTCARE
TX151206301Medicaid
TX8K3051OtherMEDICARE ID
TX00C41ROtherBLUE CROSS BLUE SHIELD
TX100785100OtherFIRSTCARE
HIH56483Medicare PIN
TX00181CMedicare ID - Type Unspecified