Provider Demographics
NPI:1992464432
Name:CASTILLO, LAURA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 HUFFMEISTER RD STE 280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3430
Mailing Address - Country:US
Mailing Address - Phone:832-632-4070
Mailing Address - Fax:
Practice Address - Street 1:10425 HUFFMEISTER RD STE 280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3430
Practice Address - Country:US
Practice Address - Phone:832-632-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant