Provider Demographics
NPI:1629220140
Name:CASTORENA, JESSICA MAYRA (RN, NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAYRA
Last Name:CASTORENA
Suffix:
Gender:F
Credentials:RN, NP
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Mailing Address - Street 1:7703 FLOYD CURL
Mailing Address - Street 2:DEPT OF PEDIATRIC CRITICAL CARE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-257-1400
Mailing Address - Fax:210-257-1428
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:DEPT OF PEDIATRIC CRITICAL CARE
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-257-1400
Practice Address - Fax:210-257-1428
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2015-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX690854363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200184405Medicaid
TX200184406OtherCSHCN
TX200184406OtherCSHCN