1073562484 NPI number — DR. MANUEL E CASTRO-ARREOLA M.D., PH.D.

Table of content: DR. MANUEL E CASTRO-ARREOLA M.D., PH.D. (NPI 1073562484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073562484 NPI number — DR. MANUEL E CASTRO-ARREOLA M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTRO-ARREOLA
Provider First Name:
MANUEL
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073562484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3430 W. WHEATLAND ROAD
Provider Second Line Business Mailing Address:
POB I SUITE 119
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-709-7110
Provider Business Mailing Address Fax Number:
972-709-7128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3430 W. WHEATLAND ROAD
Provider Second Line Business Practice Location Address:
BLDG I SUITE 119
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-709-7110
Provider Business Practice Location Address Fax Number:
972-709-7128
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  J6897 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1341620-09 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8X6740 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8X6740 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1341620-08 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8F5263 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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