Healthcare Provider Details

I. General information

NPI: 1487010989
Provider Name (Legal Business Name): MR. DIEGO CASTANEDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WILSHIRE BLVD 5TH FLOOR RM 31
LOS ANGELES CA
90010-1577
US

IV. Provider business mailing address

1065 E 3RD ST APT 14
LONG BEACH CA
90802-3450
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: