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NPI Code Detail

MEDICARE: CARMEN CASTLE OWNER

MEDICARE: CARMEN CASTLE OWNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number : 1548035330
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARMEN CASTLE OWNER
Provider Business Mailing Address
First Line : 10325 BEVERLY HILLS DR
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78410-2214
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10325 BEVERLY HILLS DR
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78410-2214
Country : US
Telephone Number : 361-724-4133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2023
Last Update Date : 11/21/2023

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