Provider Demographics
NPI:1578600383
Name:CASTANEDA, GUADALUPE JR
Entity Type:Individual
Prefix:MR
First Name:GUADALUPE
Middle Name:
Last Name:CASTANEDA
Suffix:JR
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 1:2623 RIO BRAZOS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259
Mailing Address - Country:US
Mailing Address - Phone:210-870-0907
Mailing Address - Fax:
Practice Address - Street 1:2623 RIO BRAZOS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259
Practice Address - Country:US
Practice Address - Phone:210-870-0907
Practice Address - Fax:210-267-9418
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048103K00000X
TX1-02-0994103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst