Healthcare Provider Details

I. General information

NPI: 1730044181
Provider Name (Legal Business Name): ELSA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W LA SALLE ST
CRYSTAL CITY TX
78839-4109
US

IV. Provider business mailing address

621 W LA SALLE ST
CRYSTAL CITY TX
78839-4109
US

V. Phone/Fax

Practice location:
  • Phone: 830-694-2094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1005321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: