Provider Demographics
NPI:1891784435
Name:CASTANEDA, JOSE J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:J
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9869 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6100
Mailing Address - Country:US
Mailing Address - Phone:954-450-7998
Mailing Address - Fax:954-450-9991
Practice Address - Street 1:9869 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6100
Practice Address - Country:US
Practice Address - Phone:954-450-7998
Practice Address - Fax:954-450-9991
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9103527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG445XMedicare PIN