MEDICARE: CHARISSE CASTELLANO LLOREN M.D.

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	208000000X	Pediatrics Physician	P2287	TX

General Provider Information

NPI Number	:	1275883035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISSE CASTELLANO LLOREN M.D.

Provider Business Mailing Address
First Line	:	708 SOUTH G ST.
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-8807
Country	:	US
Telephone Number	:	956-968-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 E EXPRESSWAY 83
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78599-5057
Country	:	US
Telephone Number	:	956-968-3202
Fax Number	:

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

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	08/21/2015

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