Provider Demographics
NPI:1174671325
Name:KASTANIAS, RICHARD SR
Entity Type:Individual
Prefix:MRS
First Name:RICHARD
Middle Name:
Last Name:KASTANIAS
Suffix:SR
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 1:954 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1914
Mailing Address - Country:US
Mailing Address - Phone:619-417-4923
Mailing Address - Fax:619-294-8190
Practice Address - Street 1:591 CAMINO DE LA REINA
Practice Address - Street 2:SUITE 918
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3102
Practice Address - Country:US
Practice Address - Phone:619-417-4923
Practice Address - Fax:619-294-8190
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist