Healthcare Provider Details

I. General information

NPI: 1922795723
Provider Name (Legal Business Name): MRS. ROCIO PERLA CASTANEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 HEACOCK ST
MORENO VALLEY CA
92553-3339
US

IV. Provider business mailing address

11757 CAMINO DE LA VISTA DR
MORENO VALLEY CA
92557-6415
US

V. Phone/Fax

Practice location:
  • Phone: 951-712-3529
  • Fax:
Mailing address:
  • Phone: 951-722-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: