Provider Demographics
NPI:1265206965
Name:CASTANEDA, ADELA GUADALUPE
Entity type:Individual
Prefix:
First Name:ADELA
Middle Name:GUADALUPE
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 1:2190 N SCHNOOR AVE APT 227
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4961
Mailing Address - Country:US
Mailing Address - Phone:559-536-7568
Mailing Address - Fax:
Practice Address - Street 1:2190 N SCHNOOR AVE APT 227
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4961
Practice Address - Country:US
Practice Address - Phone:559-536-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3423585106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician