Healthcare Provider Details

I. General information

NPI: 1790370534
Provider Name (Legal Business Name): JACQUELINE CASTANEDA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE CASTANEDA BCBA

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 W BALL RD STE 4A
ANAHEIM CA
92804-5589
US

IV. Provider business mailing address

15054 PADDOCK ST
SYLMAR CA
91342-5010
US

V. Phone/Fax

Practice location:
  • Phone: 714-257-5534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2834867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: