Healthcare Provider Details

I. General information

NPI: 1205277431
Provider Name (Legal Business Name): LAURA VERONICA CASTANEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 F ST PORTABLE 1
ANTIOCH CA
94509-2220
US

IV. Provider business mailing address

102 ODESSA AVE
PITTSBURG CA
94565-1944
US

V. Phone/Fax

Practice location:
  • Phone: 925-777-1133
  • Fax: 925-777-9933
Mailing address:
  • Phone: 925-206-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number791464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: