Healthcare Provider Details

I. General information

NPI: 1437083920
Provider Name (Legal Business Name): ALEXIS CASTANEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S GLADSTONE AVE
AURORA IL
60506-4877
US

IV. Provider business mailing address

5015 NORWALK CT
PLAINFIELD IL
60586-2521
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-6431
  • Fax:
Mailing address:
  • Phone: 708-218-7202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberC23501503837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: