Provider Demographics
NPI:1003562877
Name:CASTANEDA, JUAN DIEGO JR
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:DIEGO
Last Name:CASTANEDA
Suffix:JR
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 1:210 SIMPSON PKWY APT 723
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-5014
Mailing Address - Country:US
Mailing Address - Phone:509-952-3082
Mailing Address - Fax:
Practice Address - Street 1:11909 N DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1903
Practice Address - Country:US
Practice Address - Phone:509-319-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL226R7C33B106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician