=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922247881
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN CASTILLO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2009
-----------------------------------------------------
Last Update Date | 04/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13176 W LAKE HOUSTON PKWY STE. 5
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77044-5390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-436-0061
-----------------------------------------------------
Fax | 281-436-1128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7487 BROMPTON ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77025-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-667-9896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | N1577
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------