Provider Demographics
NPI:1023620200
Name:CASTANEDA, LESLIE ALEJANDRA
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ALEJANDRA
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 1:855 3RD AVE STE 1110
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1350
Mailing Address - Country:US
Mailing Address - Phone:619-934-5770
Mailing Address - Fax:
Practice Address - Street 1:855 3RD AVE STE 1110
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1350
Practice Address - Country:US
Practice Address - Phone:619-934-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician