1134428766 NPI number — DR. IVETTE LAURA CASTILLO PH.D.

Table of content: DR. IVETTE LAURA CASTILLO PH.D. (NPI 1134428766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134428766 NPI number — DR. IVETTE LAURA CASTILLO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
IVETTE
Provider Middle Name:
LAURA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1134428766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6565 WEST LOOP S
Provider Second Line Business Mailing Address:
STE. 600
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77401-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-592-8952
Provider Business Mailing Address Fax Number:
713-592-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12920 DAIRY ASHFORD RD
Provider Second Line Business Practice Location Address:
STE. 105
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-3177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-592-8952
Provider Business Practice Location Address Fax Number:
713-592-9266
Provider Enumeration Date:
03/22/2011

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: 103TC2200X , with the licence number:  32615 , 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: 288984201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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