Healthcare Provider Details

I. General information

NPI: 1912432253
Provider Name (Legal Business Name): MARISA CHRISTINIA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISA CASTILLO D.O.

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 BOB ROGERS DR STE 120
EAGLE PASS TX
78852-5942
US

IV. Provider business mailing address

3406 BOB ROGERS DR STE 120
EAGLE PASS TX
78852-5942
US

V. Phone/Fax

Practice location:
  • Phone: 830-757-4900
  • Fax: 830-757-8708
Mailing address:
  • Phone: 830-757-4900
  • Fax: 830-757-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberW3245
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: