Provider Demographics
NPI:1104971449
Name:AUGUSTO CASTRILLON MD PA
Entity type:Organization
Organization Name:AUGUSTO CASTRILLON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTRILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-519-9333
Mailing Address - Street 1:1300 S BRYAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6688
Mailing Address - Country:US
Mailing Address - Phone:956-519-9333
Mailing Address - Fax:956-519-9353
Practice Address - Street 1:1300 S BRYAN RD STE 100
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6688
Practice Address - Country:US
Practice Address - Phone:956-519-9333
Practice Address - Fax:956-519-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2025-08-11
Deactivation Date:2023-09-25
Deactivation Code:
Reactivation Date:2025-08-11
Provider Licenses
StateLicense IDTaxonomies
TXM1914207R00000X
TXK2192208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180901401Medicaid
TX180901401Medicaid