Healthcare Provider Details

I. General information

NPI: 1447027750
Provider Name (Legal Business Name): MELISSA CASTILLO LOZANO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HILL COUNTRY DR STE 202
KERRVILLE TX
78028-6024
US

IV. Provider business mailing address

16 HILLSIDE DR
CRYSTAL CITY TX
78839-3104
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-6237
  • Fax:
Mailing address:
  • Phone: 830-968-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1141452
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: