Provider Demographics
NPI:1811676935
Name:CASTILLO, ERNESTO JAVIER (SA-C)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:JAVIER
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 CROSSMILL LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6792
Mailing Address - Country:US
Mailing Address - Phone:786-602-9072
Mailing Address - Fax:
Practice Address - Street 1:2318 CROSSMILL LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6792
Practice Address - Country:US
Practice Address - Phone:786-602-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23-427246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant