Provider Demographics
NPI:1285837633
Name:CASTANEDA, RUBEN (PA-C)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2527
Mailing Address - Country:US
Mailing Address - Phone:626-359-8604
Mailing Address - Fax:626-359-8563
Practice Address - Street 1:1345 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2527
Practice Address - Country:US
Practice Address - Phone:626-359-8604
Practice Address - Fax:626-359-8563
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant