Provider Demographics
NPI:1235598384
Name:CASTANEDES, ESTELLA M (LVN)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:M
Last Name:CASTANEDES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 N SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-1632
Mailing Address - Country:US
Mailing Address - Phone:909-461-5891
Mailing Address - Fax:
Practice Address - Street 1:1651 N SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-1632
Practice Address - Country:US
Practice Address - Phone:909-461-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255299164X00000X
CA00022998374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No374700000XNursing Service Related ProvidersTechnician