Healthcare Provider Details

I. General information

NPI: 1841516192
Provider Name (Legal Business Name): MARCELA C CASTILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 07/21/2022
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HILLCREST MEDICAL BLVD STE 300
WACO TX
76712-8951
US

IV. Provider business mailing address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

V. Phone/Fax

Practice location:
  • Phone: 254-313-6500
  • Fax: 254-313-6599
Mailing address:
  • Phone: 254-313-4200
  • Fax: 254-313-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR3484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: