Provider Demographics
NPI:1508018987
Name:CASTANEDA, NOEMI (LMP)
Entity Type:Individual
Prefix:MS
First Name:NOEMI
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2347
Mailing Address - Country:US
Mailing Address - Phone:509-839-0414
Mailing Address - Fax:509-839-8847
Practice Address - Street 1:841 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2347
Practice Address - Country:US
Practice Address - Phone:509-839-0414
Practice Address - Fax:509-839-8847
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60014018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist