MEDICARE: JOSEPHINE CASTILLO

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	2355S0801X	Speech-Language Assistant	44077	TX

General Provider Information

NPI Number	:	1235962184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE CASTILLO

Provider Business Mailing Address
First Line	:	305 NE LOOP 820 STE 200
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-7211
Country	:	US
Telephone Number	:	817-292-8787
Fax Number	:	817-789-6849

Provider Business Practice Location Address
First Line	:	101 W HILLSIDE RD STE 6B
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-3181
Country	:	US
Telephone Number	:	956-722-6221
Fax Number	:	956-722-6275

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

Provider Enumeration Date	:	08/24/2024
Last Update Date	:	08/24/2024

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Directions to “ JOSEPHINE CASTILLO ” Practice Location

Language	Start Address	Practice Location

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