MEDICARE: MAYLEN CASTRO GUERRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	988416	TX
2	363LF0000X	Family Nurse Practitioner	1081260	TX

General Provider Information

NPI Number	:	1003438615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYLEN CASTRO GUERRA

Provider Business Mailing Address
First Line	:	1888 BARKER CYPRESS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-4578
Country	:	US
Telephone Number	:	281-840-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1888 BARKER CYPRESS RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-4578
Country	:	US
Telephone Number	:	281-840-1455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	02/14/2024

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