Healthcare Provider Details

I. General information

NPI: 1104874080
Provider Name (Legal Business Name): MAJIN MIGUEL CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 CASTROVILLE RD SUITE 120
SAN ANTONIO TX
78237-3153
US

IV. Provider business mailing address

6243 IH 10 W SUITE 480
SAN ANTONIO TX
78201-2086
US

V. Phone/Fax

Practice location:
  • Phone: 210-436-7402
  • Fax: 210-436-7398
Mailing address:
  • Phone: 210-731-4800
  • Fax: 210-731-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL8004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: