Healthcare Provider Details

I. General information

NPI: 1780454561
Provider Name (Legal Business Name): ALLYSSA LORIAN CASTILLO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 HAMILTON WOLFE RD STE 200
SAN ANTONIO TX
78229-3458
US

IV. Provider business mailing address

521 LOCKWOOD ST
SAN MARCOS TX
78666-7402
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax:
Mailing address:
  • Phone: 512-214-9946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1139450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: