Provider Demographics
NPI:1336232032
Name:CASTANEDA, CLEMENTE
Entity Type:Individual
Prefix:
First Name:CLEMENTE
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 W MOONRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2613
Mailing Address - Country:US
Mailing Address - Phone:714-554-5787
Mailing Address - Fax:
Practice Address - Street 1:14795 JEFFREY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0414
Practice Address - Country:US
Practice Address - Phone:949-654-9163
Practice Address - Fax:949-654-8207
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)