Provider Demographics
NPI:1467299396
Name:CASTANUELA, JESSIKA ROSE
Entity type:Individual
Prefix:
First Name:JESSIKA
Middle Name:ROSE
Last Name:CASTANUELA
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 1:10501 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-2313
Mailing Address - Country:US
Mailing Address - Phone:303-343-3336
Mailing Address - Fax:303-343-6152
Practice Address - Street 1:10501 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2313
Practice Address - Country:US
Practice Address - Phone:303-343-3336
Practice Address - Fax:303-343-6152
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00020091581835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric