MEDICARE: ANNA MAE DELA CRUZ CASTILLEJA NP

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	363L00000X	Nurse Practitioner	AP137745	TX
2	390200000X	Student in an Organized Health Care Education/Training Program		TX

General Provider Information

NPI Number	:	1194218289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MAE DELA CRUZ CASTILLEJA NP

Provider Business Mailing Address
First Line	:	PO BOX 3397
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78044-3397
Country	:	US
Telephone Number	:	956-795-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 SHILOH DR STE 1
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-7402
Country	:	US
Telephone Number	:	956-718-6281
Fax Number	:

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

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	05/09/2024

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