Healthcare Provider Details

I. General information

NPI: 1043048507
Provider Name (Legal Business Name): CARRIE CASTANEDA-SOUND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 ELIZONDO AVE
SIMI VALLEY CA
93065-4713
US

IV. Provider business mailing address

2735 ELIZONDO AVE
SIMI VALLEY CA
93065-4713
US

V. Phone/Fax

Practice location:
  • Phone: 805-285-3375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number25182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: