Basic Information
Provider Information
NPI: 1790763373
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASTRO
FirstName: JOSE
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: CSTCFA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3744
Address2:  
City: MCALLEN
State: TX
PostalCode: 785023744
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1305 E NOLANA ST
Address2: SUITE A
City: MCALLEN
State: TX
PostalCode: 785046114
CountryCode: US
TelephoneNumber: 9566824152
FaxNumber: 9566824154
Other Information
ProviderEnumerationDate: 01/04/2006
LastUpdateDate: 01/07/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246ZS0410XF01198TXY    

ID Information
IDTypeStateIssuerDescription
0025JR01TXBCBSOTHER


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