1851375422 NPI number — GRACE H. CASTRO-ANDRES MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851375422 NPI number — GRACE H. CASTRO-ANDRES MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CASTRO-ANDRES

Provider First Name:

GRACE

Provider Middle Name:

H.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1851375422

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/04/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 660599

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DALLAS

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75266-0599

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1800 N BRITAIN RD

Provider Second Line Business Practice Location Address:

IRVING HEALTH CENTER

Provider Business Practice Location Address City Name:

IRVING

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

75061-2630

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

214-266-3000

Provider Business Practice Location Address Fax Number:

214-266-3049

Provider Enumeration Date:

12/06/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  J7445 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 138908211 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908212 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908210 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 110200810 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 138908206 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908207 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908214 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908208 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908213 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 87W583 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 138908201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 138908202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".