Organization
JOHN & PATRICIA GONZALES
Active
Other names
Divine Children's Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY F. CASTILLEJA M.D. (MEDICAL DIRECTOR)
(956) 464-3649
Entity
Organization
Contact information
Practice address
701 N MAIN ST, DONNA, TX 78537-2765
(956) 464-3649
(956) 464-3670
Mailing address
701 N MAIN ST, SUITE B, DONNA, TX 78537-2765
(956) 464-3649
(956) 464-3670
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190228001
—
TX
Enumeration date
05/07/2008
Last updated
10/14/2015
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