Healthcare Provider Details

I. General information

NPI: 1427791292
Provider Name (Legal Business Name): MARIA CASTANEDA-ALCARAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31764 CASINO DR # 300
LAKE ELSINORE CA
92530-2312
US

IV. Provider business mailing address

31764 CASINO DR
LAKE ELSINORE CA
92530-2312
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-7098
  • Fax: 951-471-4687
Mailing address:
  • Phone: 951-203-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: