Healthcare Provider Details

I. General information

NPI: 1639442353
Provider Name (Legal Business Name): JESUS I. CASTILLO RPSGT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 07/10/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SOUTH FIRST STREET (HSC) POLYSOMNOGRAPHY
TEMPLE TX
76504
US

IV. Provider business mailing address

307 E MAIN ST
FLORENCE TX
76527-4048
US

V. Phone/Fax

Practice location:
  • Phone: 254-298-8673
  • Fax:
Mailing address:
  • Phone: 254-291-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number135254
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1344-5635
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number13841
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: