Healthcare Provider Details

I. General information

NPI: 1710456769
Provider Name (Legal Business Name): SERGIO ALFREDO CASTANEDA MUNGUIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N D ST
SAN BERNARDINO CA
92401-1734
US

IV. Provider business mailing address

290 N D ST
SAN BERNARDINO CA
92401-1734
US

V. Phone/Fax

Practice location:
  • Phone: 909-963-5355
  • Fax: 909-313-2320
Mailing address:
  • Phone: 909-963-5355
  • Fax: 909-313-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126568
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW126568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: