Healthcare Provider Details

I. General information

NPI: 1578393013
Provider Name (Legal Business Name): ERIKA CASTANEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 9TH ST STE D
MODESTO CA
95354-3438
US

IV. Provider business mailing address

121 DOWNEY AVE
MODESTO CA
95354-1208
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4598
  • Fax:
Mailing address:
  • Phone: 209-341-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number126000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: