Provider Demographics
NPI:1407291453
Name:CASTANEDA, ELIEZER (MD)
Entity Type:Individual
Prefix:
First Name:ELIEZER
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 JAMES COLEMAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3111
Mailing Address - Country:US
Mailing Address - Phone:361-573-4000
Mailing Address - Fax:361-485-0672
Practice Address - Street 1:202 JAMES COLEMAN DR STE A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3111
Practice Address - Country:US
Practice Address - Phone:361-573-4000
Practice Address - Fax:361-485-0672
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine