Provider Demographics
NPI:1033302534
Name:ERIC CARL CASTANEDA
Entity Type:Organization
Organization Name:ERIC CARL CASTANEDA
Other - Org Name:DIAMOND SPRINGS MOBILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-626-7638
Mailing Address - Street 1:484 PLEASANT VALLEY RD.
Mailing Address - Street 2:SUITE #20
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9472
Mailing Address - Country:US
Mailing Address - Phone:530-626-7638
Mailing Address - Fax:530-626-3789
Practice Address - Street 1:484 PLEASANT VALLEY RD.
Practice Address - Street 2:SUITE #20
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9472
Practice Address - Country:US
Practice Address - Phone:530-626-7638
Practice Address - Fax:530-626-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103039332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03242FMedicaid
CA5263580001Medicare NSC