Provider Demographics
NPI:1669667788
Name:EVANGELINA CASTANEDA M.D., P.A.
Entity Type:Organization
Organization Name:EVANGELINA CASTANEDA M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANEDADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-985-1312
Mailing Address - Street 1:4100 W 15TH ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5803
Mailing Address - Country:US
Mailing Address - Phone:972-985-1312
Mailing Address - Fax:972-596-7192
Practice Address - Street 1:4100 W 15TH ST
Practice Address - Street 2:SUITE 118
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5803
Practice Address - Country:US
Practice Address - Phone:972-985-1312
Practice Address - Fax:972-596-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2341207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00SZ56Medicare PIN