Provider Demographics
NPI:1790375079
Name:CASTANEDA, NIVEA
Entity Type:Individual
Prefix:DR
First Name:NIVEA
Middle Name:
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 1:6973 W WINSTON LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5102
Mailing Address - Country:US
Mailing Address - Phone:775-721-0466
Mailing Address - Fax:
Practice Address - Street 1:6550 W EMERALD ST STE 108
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8780
Practice Address - Country:US
Practice Address - Phone:208-344-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor