MEDICARE: MR. ROBERTO CASTILLERO MED

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	103TS0200X	School Psychologist	12221	TX

General Provider Information

NPI Number	:	1225166960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERTO CASTILLERO MED

Provider Business Mailing Address
First Line	:	PO BOX 396
Second Line	:
City	:	LYFORD
State	:	TX
Zip	:	78569-0396
Country	:	US
Telephone Number	:	956-966-4506
Fax Number	:

Provider Business Practice Location Address
First Line	:	378 WEST GLEN LOFTON ST
Second Line	:
City	:	LYFORD
State	:	TX
Zip	:	78569-0396
Country	:	US
Telephone Number	:	956-966-4506
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. ROBERTO CASTILLERO MED” Practice Location

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