Healthcare Provider Details

I. General information

NPI: 1356197644
Provider Name (Legal Business Name): JUAN CASTANEDA CADT I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

2085 RUSTIN AVE BLDG 3
RIVERSIDE CA
92507-2498
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-5188
  • Fax:
Mailing address:
  • Phone: 951-358-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCI50130126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: