Healthcare Provider Details

I. General information

NPI: 1134036718
Provider Name (Legal Business Name): MARYCRUZ CASTANEDA M.ED.,ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E. CESAR CHAVEZ BLVD
SAN LUIS AZ
85349
US

IV. Provider business mailing address

234 E ZAPATA ST
SAN LUIS AZ
85336-0967
US

V. Phone/Fax

Practice location:
  • Phone: 928-627-6545
  • Fax: 928-627-3635
Mailing address:
  • Phone: 928-627-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4784544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: