Healthcare Provider Details

I. General information

NPI: 1609861251
Provider Name (Legal Business Name): PEDRO CASTANEDA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

IV. Provider business mailing address

1515 PAPPAS ST
LAREDO TX
78041-1705
US

V. Phone/Fax

Practice location:
  • Phone: 956-795-8100
  • Fax: 956-718-6294
Mailing address:
  • Phone: 956-795-8100
  • Fax: 956-718-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberE-1824
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: