Provider Demographics
NPI:1417350539
Name:CASTANEDA, DANIELLE MARIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:MARIE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 S GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5222
Mailing Address - Country:US
Mailing Address - Phone:909-620-8088
Mailing Address - Fax:909-623-4861
Practice Address - Street 1:1555 S GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5222
Practice Address - Country:US
Practice Address - Phone:909-620-8088
Practice Address - Fax:909-623-4861
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse