Healthcare Provider Details

I. General information

NPI: 1093702987
Provider Name (Legal Business Name): EDUARDO A. CASTREJON M.D. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S SOLANO DR
LAS CRUCES NM
88001-3755
US

IV. Provider business mailing address

1205 S SOLANO DR
LAS CRUCES NM
88001-3755
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-9119
  • Fax: 505-525-1889
Mailing address:
  • Phone: 505-524-9119
  • Fax: 505-525-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNM82-19
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: