Provider Demographics
NPI:1649739301
Name:CASTANEDA, MAYELIZA DESIREE
Entity Type:Individual
Prefix:
First Name:MAYELIZA
Middle Name:DESIREE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11224 VOLLMER LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-1793
Mailing Address - Country:US
Mailing Address - Phone:210-993-3121
Mailing Address - Fax:
Practice Address - Street 1:11224 VOLLMER LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-1793
Practice Address - Country:US
Practice Address - Phone:210-993-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX928039163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health