Healthcare Provider Details

I. General information

NPI: 1306214531
Provider Name (Legal Business Name): JOEL CASTANEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

IV. Provider business mailing address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

V. Phone/Fax

Practice location:
  • Phone: 323-558-7686
  • Fax: 323-201-9378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: