Healthcare Provider Details

I. General information

NPI: 1588365076
Provider Name (Legal Business Name): ELSA ANN CASTANON QUINTANA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELSA ANN CASTANON

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S BREA CANYON ROAD SUITE 330
DIAMOND BAR CA
91789
US

IV. Provider business mailing address

888 S BREA CANYON ROAD SUITE 330
DIAMOND BAR CA
91789
US

V. Phone/Fax

Practice location:
  • Phone: 909-594-3382
  • Fax:
Mailing address:
  • Phone: 909-594-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: