Provider Demographics
NPI:1417667460
Name:CASTANEDA, CARLOS DANIEL
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:DANIEL
Last Name:CASTANEDA
Suffix:
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 1:3348 PITCAIRN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1325
Mailing Address - Country:US
Mailing Address - Phone:408-569-6645
Mailing Address - Fax:
Practice Address - Street 1:2033 GATEWAY PL STE 526
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3712
Practice Address - Country:US
Practice Address - Phone:669-205-1778
Practice Address - Fax:886-568-1178
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician