Provider Demographics
NPI:1053912311
Name:PUNO, JOSE LORENZO CASTANEDA
Entity type:Individual
Prefix:
First Name:JOSE LORENZO
Middle Name:CASTANEDA
Last Name:PUNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 DEER SAGE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-6837
Mailing Address - Country:US
Mailing Address - Phone:832-606-6505
Mailing Address - Fax:
Practice Address - Street 1:4016 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-5163
Practice Address - Country:US
Practice Address - Phone:281-337-3595
Practice Address - Fax:281-337-4759
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67652183500000X
TX10648333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4554184OtherIT JUST SAYS NON-MEDICARE
TX462220Medicaid