Healthcare Provider Details

I. General information

NPI: 1023866647
Provider Name (Legal Business Name): PATRIC CRUZ CASTILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N MCKINLEY ST
HOBBS NM
88240-8256
US

IV. Provider business mailing address

PO BOX 907
HOBBS NM
88241-0907
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-0755
  • Fax:
Mailing address:
  • Phone: 575-393-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0163
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: