Healthcare Provider Details

I. General information

NPI: 1952635658
Provider Name (Legal Business Name): LUIS ANTONIO CASTAGNINI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS ANTONIO CASTAGNINI-CASTRO M.D

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA ST
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

315 N SAN SABA SUITE 1003
SAN ANTONIO TX
78207-3154
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-3391
  • Fax:
Mailing address:
  • Phone: 210-704-3391
  • Fax: 210-704-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number38636
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: