Healthcare Provider Details

I. General information

NPI: 1124901202
Provider Name (Legal Business Name): ERNEST JASON CASTANEDA JR. NA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46900 MONROE ST STE A101
INDIO CA
92201-4828
US

IV. Provider business mailing address

2085 RUSTIN AVE STE 1
RIVERSIDE CA
92507-2498
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-7219
  • Fax:
Mailing address:
  • Phone: 951-955-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: