Provider Demographics
NPI:1992786321
Name:CASTILLO, MARIO J (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:J
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 NORTH LOOP W STE 240
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1677
Mailing Address - Country:US
Mailing Address - Phone:713-426-4010
Mailing Address - Fax:713-426-4015
Practice Address - Street 1:1601 W 11TH PL
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4114
Practice Address - Country:US
Practice Address - Phone:281-359-7788
Practice Address - Fax:281-359-7888
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME585422085R0202X
TXK90332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253067800Medicaid
TX044108104Medicaid
TX044108104Medicaid
F22734Medicare UPIN
P00454828Medicare PIN
TX613007Medicare PIN