Healthcare Provider Details

I. General information

NPI: 1285661504
Provider Name (Legal Business Name): RICARDO CASTELLANOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 AVENUE E MADINA REGIONAL HOSPITAL
HONDO TX
78861-3534
US

IV. Provider business mailing address

7213 DEEP LN
AUSTIN TX
78774-6400
US

V. Phone/Fax

Practice location:
  • Phone: 830-393-3122
  • Fax:
Mailing address:
  • Phone: 512-789-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF3819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: