Healthcare Provider Details

I. General information

NPI: 1184341778
Provider Name (Legal Business Name): MATTHEW CASTANON CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 COPPER LOOP
LAS CRUCES NM
88005-8139
US

IV. Provider business mailing address

14805 ORSTEN ARTIS AVE
EL PASO TX
79938-4670
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-7643
  • Fax: 575-647-7630
Mailing address:
  • Phone: 915-252-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70214
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: