Provider Demographics
NPI:1184958431
Name:CASTANEDA, JUAN FERNANDO (PA-C)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:FERNANDO
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:FERNANDO
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6470 NAPLES DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4167
Mailing Address - Country:US
Mailing Address - Phone:915-867-3989
Mailing Address - Fax:
Practice Address - Street 1:707 HIGHLANDER BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4319
Practice Address - Country:US
Practice Address - Phone:855-416-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06346363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical